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2023 HSR&D/QUERI National Conference Abstract

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1113 — A Multisite Randomized Trial of a Veteran-Centric Lung Cancer Screening Decision Aid

Lead/Presenter: Marilyn Schapira
All Authors: Schapira MM (Center for Health Equity Research and Promotion (CHERP), Philadelphia, PA), Hubbard, R (University of Pennsylvania School of Medicine, Philadelphia, PA) Whittle, J (Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee, WI) Vachani, A (Corporal Michael J Crescenz VAMC and the University of Pennsylvania, Philadelphia, PA) Akers, S (Corporal Michael J Crescenz VAMC and the University of Pennsylvania, Philadelphia) Schrand, S (Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA) Kaminstein, D (Center for Health Equity Research and Promotion, Philadelphia, PA and University of Pennsylvania, Philadelphia, PA) Bastian, LA (VA Connecticut Healthcare System, West Haven, CT and Yale University School of Medicine, New Haven, CT) Kravetz, JD (VA Connecticut Healthcare System, West Haven, CT and Yale University School of Medicine, New Haven, CT) Rodriguez KL (Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System and the University of Pittsburgh, Pittsburgh, PA) Asan,O (The Stevens Institute of Technology, Hoboken, NJ) Chhatre, \S (Center for Health Equity Research and Promotion and the University of Pennsylvania, Philadelphia, PA) Prigge, J (Center for Health Equity Research and Promotion, Philadelphia, PA) Meline, J (Center for Health Equity Research and Promotion, Philadelphia, PA) Dye, D (Zablocki VA Medical Center, Milwaukee, WI) Rieder, J (Zablocki VA Medical Center, Milwaukee, WI) Ibarra, JV (VA Connecticut Healthcare System, West Haven, CT) Corn, B (VA Connecticut Healthcare System, West Haven, CT) Frempong,J (University of Pennsylvania School of Medicine, Philadelphia, PA) Fraenkel, L(Berkshire Health Systems, Pittsfield, MA and Yale University, New Haven, CT)

Objectives:
Guidelines recommend shared decision making prior to the initiation of lung cancer screening (LCS). However, we lack evidence on the efficacy of LCS patient decision aids (PtDAs) on the quality of decision making and health outcomes. Veterans are at higher risk of lung cancer than the general population as well as higher rates of comorbidities that could impact their decisions about LCS. The objective of this study was to evaluate the efficacy of a Veteran Centric Lung Cancer Screening Decision Tool (LCSDecTool) on decision making and health outcomes in the setting of a primary care clinic visit.

Methods:
We conducted a multisite (Philadelphia, West Haven, and Milwaukee VAMC) randomized clinical trial of a web-based LCSDecTool compared to a control intervention. The tool was developed by our group with input from Veteran stakeholders. Veterans were eligible if enrolled in primary care at a participating VAMC, 55 to 80 years of age, had a 30 pack year smoking history, and continued to smoke within the past 15 years. Veterans who had LCS within 15 months were excluded. The LCSDecTool or control intervention was used by Veterans directly before a primary care visit. Patient reported outcomes were measured post-intervention and at 1 and 3 months. The primary outcome was decisional conflict as measured by the decisional conflict scale (DCS) at 1 month. Secondary outcomes were LCS knowledge, anxiety (STAI). LCS uptake was determined by chart review at 6 months.

Results:
We enrolled 142 participants. The median (IQR) age was 64.9 (61.0, 69.0), 91.1% were male, 54.7% were African American or Black and 45.3% were White; 3% had missing race data. Post-intervention DCS (range 0-100) scores (mean, 95% CI) were lower in the intervention vs. control group: 22.2 (18.3, 26.0) vs 31.1 (26.1, 36.0), p = 0.00. This difference did not remain statistically significant at 1 or 3 months. Post-intervention LCS knowledge (range 0 to 12) was greater (mean, 95%CI) in the intervention vs. control group: 7.9 (6.3, 7.7) vs. 4.9 (4.3, 5.5), p < 0.001 and remained greater at 1 and 3 months. Anxiety scores did not differ across groups at any time point. LCS uptake at 6 months was greater in the intervention vs, control group (38.2% vs. 20.8%), p = 0.03.

Implications:
We report that the use of a Veteran-Centric LCSDecTool used at point of care improved knowledge, decreased decisional conflict and increased uptake of LCS without increasing anxiety.

Impacts:
This study provides evidence that integration of a LCS shared decision making tool in the VA primary care setting improves patient knowledge and the quality of decision making. Further studies are needed to address successful implementation of LCS decision support tools more broadly in the primary care setting.