A pre-post study testing a lung cancer screening decision aid in primary care

Abstract Background The United States Preventive Services Task Force (USPSTF) issued recommendations for older, heavy lifetime smokers to complete annual low-dose computed tomography (LDCT) scans of the chest as screening for lung cancer. The USPSTF recommends and the Centers for Medicare and Medicaid Services require shared decision making using a decision aid for lung cancer screening with annual LDCT. Little is known about how decision aids affect screening knowledge, preferences, and behavior. Thus, we tested a lung cancer screening decision aid video in screening-eligible primary care patients. Methods We conducted a single-group study with surveys before and after decision aid viewing and medical record review at 3 months. Participants were active patients of a large US academic primary care practice who were current or former smokers, ages 55–80 years, and eligible for screening based on current screening guidelines. Outcomes assessed pre-post decision aid viewing were screening-related knowledge score (9 items about screening-related harms of false positives and overdiagnosis, likelihood of benefit; score range = 0–9) and preference (preferred screening vs. not). Screening behavior measures, assessed via chart review, included provider visits, screening discussion, LDCT ordering, and LDCT completion within 3 months. Results Among 50 participants, knowledge increased from pre- to post-decision aid viewing (mean = 2.6 vs. 5.5, difference = 2.8; 95% CI 2.1, 3.6, p < 0.001). Preferences across the overall sample remained similar such that 54% preferred screening at baseline and 50% after viewing; however, 28% of participants changed their preference (to or away from screening) from baseline to after viewing. We assessed screening behavior for 36 participants who had a primary care visit during the 3-month period following enrollment. Eighteen of 36 preferred screening after decision aid viewing. Of these 18, 10 discussed screening, 8 had a test ordered, and 6 completed LDCT. Among the 18 who preferred no screening, 7 discussed screening, 5 had a test ordered, and 4 completed LDCT. Conclusions In primary care patients, a lung cancer screening decision aid improved knowledge regarding screening-related benefits and harms. Screening preferences and behavior were heterogeneous. Trial registration This study is registered at www.clinicaltrials.gov . NCT03077230 (registered retrospectively,November 22, 2016)

Occupational screening

Medical screening of workers is one of the tools often used to assess suitability for work and to attempt to reduce worker ill-health. This article outlines the objectives of the screening process and the basic criteria to be followed in developing a quality programme. It describes the different types of medical examination used in this setting. Screening programmes should be related to hazards specific to the work place as well as to the physical and mental requirements of the job. The guiding principle in the prevention of occupational disease should always be the control of hazardous exposure to prevent harmful effects occurring rather than early detection of harmful effects after they have occurred. The importance of being aware of and abiding by these principles is particularly applicable in the local context.peer-reviewe

Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial

Objective To evaluate the impact of telling patients their estimated spirometric lung age as an incentive to quit smoking.Design Randomised controlled trial.Setting Five general practices in Hertfordshire, England.Participants 561 current smokers aged over 35.Intervention All participants were offered spirometric assessment of lung function. Participants in intervention group received their results in terms of "lung age" (the age of the average healthy individual who would perform similar to them on spirometry). Those in the control group received a raw figure for forced expiratory volume at one second (FEV1). Both groups were advised to quit and offered referral to local NHS smoking cessation services.Main outcome measures The primary outcome measure was verified cessation of smoking by salivary cotinine testing 12 months after recruitment. Secondary outcomes were reported changes in daily consumption of cigarettes and identification of new diagnoses of chronic obstructive lung disease.Results Follow-up was 89%. Independently verified quit rates at 12 months in the intervention and control groups, respectively, were 13.6% and 6.4% (difference 7.2%, P=0.005, 95% confidence interval 2.2% to 12.1%; number needed to treat 14). People with worse spirometric lung age were no more likely to have quit than those with normal lung age in either group. Cost per successful quitter was estimated at 280 pound ((euro) 365, $556). A new diagnosis of obstructive lung disease was made in 17% in the intervention group and 14% in the control group; a total of 16% (89/561) of participants.Conclusion Telling smokers their lung age significantly improves the likelihood of them quitting smoking, but the mechanism by which this intervention achieves its effect is unclear.Trial registration National Research Register N0096173751

An Educational Toolkit to Promote Lung Cancer Screening in Primary Care

Lung cancer is the leading cause of cancer mortality in the United States for both men and women. Lung cancer screening with low-dose computed tomography (LDCT) demonstrates reductions in lung cancer mortality and all-cause mortality, and improved rates of early stage diagnosis in high-risk current and former adult smokers. Evidence-based screening guidelines include annual LDCT in high-risk current and former adult smokers; however, these guidelines have not been fully translated into clinical practice. The purpose of this project was to create a toolkit for lung cancer screening to assist primary care providers in educating and screening their patients at high-risk for lung cancer with an overall goal of reducing lung cancer mortality and improving early stage diagnosis of lung cancer. An educational intervention using single group post-test was carried out in a primary care practice. Providers were asked to use a toolkit that included resources for lung cancer screening in clinical practice. Survey data was collected to determine effectiveness of the toolkit and educational intervention. Analysis of the data indicated that the toolkit may be beneficial to practice, although there were provider concerns about time and patient receptiveness. Lung cancer is a significant cause of mortality; giving providers tools to educate and screen high-risk patients for lung cancer may reduce mortality rates and improve survival

The Effect of Implementing an Evidence-Based Family History Screening Tool in the Primary Care Setting to Increase the Identification of Patients at Risk for Hereditary Breast and Ovarian Cancer Syndrome A Quality Improvement Project

Improvement of identification and education of Hereditary Breast and Ovarian Cancer Syndrome (HBOC) among primary care providers was the focus of this quality improvement project. The development of a pre-implementation and post-implementation survey along with the distribution of a family history screening tool and the Evidence-Based Practice Guidelines provided by the Centers for Disease Control was introduced for the intervention. The anonymous surveys were distributed to primary care providers at the University of Miami in Miami-Dade County locations. Participants recruited for this quality improvement project included Doctors (MD, DO), Nurse practitioners, and Physician assistants currently practicing in primary care. The quality improvement project included two surveys using clinical scenarios to assess primary care providers\u27 knowledge in identifying patients at an increased risk for HBOC. The providers willing to participate began by taking a pre-implantation survey to assess their baseline knowledge. The providers then received the Evidence-based Practice Guidelines Supporting Genetic Susceptibility Testing for Hereditary Breast and Ovarian Cancer Syndrome and the seven-question family history screening tool. They were then asked to review and implement these tools into their practice for 6 weeks. After the completion of the 6 weeks, the providers were then asked to complete a second survey using the provided family history screening tool to answer clinical scenario questions. Family history and screening tools were designed to identify at-risk patients for HBOC. On average, the post-implementation clinical scenario questions while utilizing the family history screening tool showed an increase in the identification of patients at risk for HBOC in comparison to the pre-implantation clinical scenario questions where no family history screening tool was used. While this project cannot make final conclusions due to its sample size, it can open opportunities for further validation of this theory and bring further evidence to translate research into changing clinical practice to better serve the community

Jefferson Digital Commons quarterly report: January-March 2020

This quarterly report includes: New Look for the Jefferson Digital Commons Articles COVID-19 Working Papers Educational Materials From the Archives Grand Rounds and Lectures JeffMD Scholarly Inquiry Abstracts Journals and Newsletters Master of Public Health Capstones Oral Histories Posters and Conference Presentations What People are Saying About the Jefferson the Digital Common

A Lung Cancer Screening Personalized Decision-aid Improves Knowledge and Reduces Decisional Conflict Among a Diverse Population of Smokers at an Urban Academic Medical Center

Introduction: Few lung cancer screening decision aids have been tested in diverse populations. The study objective was to determine whether the online decision aid www.shouldiscreen.com impacts knowledge of and decisional conflict around lung cancer screening in a diverse population. Methods: Eligible patients had significant smoking histories, were at increased risk for lung cancer (ages 45-80, \u3e20 pack-years, smoking within last 15 years) and had no history of prior lung cancer or screening. Data was collected and analyzed in 2017. Results: 40 patients were enrolled: 80% were female, 62.5% black, 33% white, and 48% had a high school education or less. 80% were current smokers with a mean of 34 pack-years accumulated. 35% were eligible for screening by U.S. Preventive Services Task Force criteria. After reviewing the decision aid, knowledge increased in all categories including risk factors for lung cancer (3.58 to 4.30, p\u3c0.01), benefits of screening (1.58 to 2.30, p\u3c0.01), possible harms of screening (0.93 to 2.08, p\u3c0.01), and eligibility for screening (2.10 to 2.65, p\u3c0.01). Decisional conflict was reduced from 21.25 to 8.65 (p\u3c0.01). After use of the decision aid, more patients expressed a preference not to be screened for lung cancer, such that concordance with USPSTF guidelines decreased among those who were eligible to screen increased among those who did not yet meet eligibility criteria; however, this finding was not statistically significant. Conclusions: Even brief, unguided use of this web-based tool improved knowledge and reduced decisional conflict for a diverse group of smokers considering lung cancer screening