Lung Cancer Screening Decision Tool (LCSDecTool)

In the United States, lung cancer is the third most common cancer and the leading cause of cancer deaths among both men and women. Military veterans are at higher risk of developing lung cancer than civilians because they are more likely than civilians to use tobacco. 

Individuals at highest risk for developing lung cancer—those who 1) have at least a 20 pack-year smoking history, 2) currently smoke or have quit within the past 15 years, and 3) are between the ages of 50 and 80—may benefit from LCS. Among these individuals at highest risk, LCS has been shown to decrease the risk of dying from lung cancer by diagnosing it early, when treatment is most likely to be effective. LCS carries risks, however, such as false positives, overdiagnosis, and exposure to radiation.  

Shared decision-making interventions are needed to help those who are at high risk of developing lung cancer make a well-informed decision about whether to be screened for the disease.

The Lung Cancer Screening Decision Tool (LCSDecTool) is a program for veterans at high risk for lung cancer. The program is designed to enhance knowledge and reduce decisional conflict for these veterans as they decide whether to receive lung cancer screening. 

Patients at high risk for lung cancer are given the LCSDecTool prior to a scheduled visit with their clinician. The tool is self-paced and includes the following components: an overview of LCS using a simulated patient-provider dialogue, facts about LCS (e.g., lung cancer mortality, over-diagnosis, level of radiation), an infographic depicting lung cancer outcomes with and without screening, a value elicitation exercise in which the patient indicates how they feel about the potential benefits and harms of screening so they can determine what is most important to them as they make a decision, smoking cessation advice, mental health resources, and the option to request a smoking cessation referral. The tool allows the patient to type questions as they advance through the various sections so they can discuss the questions at their scheduled visit with a clinician. After the patient completes the tool, they share their value ratings and a list of their questions with their provider.

Prior to the patient’s appointment, the provider should review the LCSDecTool.

The study reviewed for this summary used a web-based version of the intervention.

-- Minimal time to identify patients for LCS and provide them with the LCSDecTool
-- Approximately 15 minutes for the patient to complete the tool
-- Approximately 10 minutes for the provider to review the LCSDecTool

The intervention is intended for veterans who are at high risk for lung cancer and are eligible for LCS.

The program is suitable for implementation in the home and in clinical settings.

Required resources to implement the program include the following:
-- Lung Cancer Screening Decision Tool (LCSDecTool) (PDF Document)

For costs associated with this program, click on Contact the Program Developer on the Program Materials page.

A randomized controlled trial was conducted to evaluate the impact of the LCSDecTool and a control condition on decision-making for patients eligible for lung cancer screening at Veterans Affairs Medical Centers in Philadelphia, Pennsylvania; Milwaukee, Wisconsin; and West Haven, Connecticut. Patients aged 55 to 80 years who were actively smoking or had quit smoking in the past 15 years, had a history of at least 30 pack-years of smoking, and had an upcoming appointment in primary care within 3 weeks were eligible to participate. Patients were excluded if they had a cancer diagnosis (other than nonmelanoma skin cancer or prostate cancer not requiring active treatment) or had a life expectancy of less than 2 years as assessed by a primary care clinician. 

Participants assigned to the intervention group (n=69) were given access to the LCSDecTool prior to a clinic visit and had the opportunity to print or save the summary page from the tool so they could discuss it with their clinician during their visit. Participants assigned to the control group (n=71) were given access to a 10-page web-based guide, Cancer Prevention: An Information Guide. The guide included information on cancer prevention and screening guidelines for breast, colon, cervical, and lung cancer. 

The majority of patients were men (92.1%); 53.6% were African American or Black, 44.3% were White, and 2.9% were Hispanic or Latino. 

The primary outcomes were LCS uptake, decisional conflict, and LCS knowledge. LCS uptake was measured 6 and 9 months after the intervention through a review of electronic health records. Decisional conflict was measured immediately after the intervention and 1 and 3 months later using the Decisional Conflict Scale, a 16-item self-report survey. Scores range from 0 to 100, with a higher score indicating greater conflict. LCS knowledge was measured immediately after the intervention and 1 and 3 months later using a 12-item true/false instrument. Scores ranged from 0 to 12 with higher scores representing greater knowledge.

• A higher percentage of intervention group participants received LCS at 6-month follow-up (p=.04) and 9-month follow-up (p=.02) than control group participants.

• The intervention group had a lower mean score on the Decisional Conflict Scale than the control group, indicating lower decisional conflict, immediately after the intervention (p=.004). No differences in decisional conflict were found between the two groups at 1- and 3-month follow-up.

• The intervention group had greater LCS knowledge than the control group immediately after the intervention (p<.001), at 1-month follow-up (p=.03), and at 3-month follow-up (p=.01).