Primary care providers (PCPs) often have less than 5 minutes to discuss substantive, high-volume decisions like cancer screening. My CDA focuses on providing the foundational research and preparation necessary to learn how to use decision support to personalize these tough decisions in primary care settings. To accomplish these goals, I will conduct initial research in the low-dose computed tomography lung cancer-screening (LCS) context. Even more than other preventive services, it is difficult to know which patients can expect enough benefit from LCS to justify exposure to the harms. Some eligible Veterans can expect large health gains while others face a fine balance of benefit and harm. More difficult yet is explaining to patients the trade-offs of screening for them personally. A better understanding of how to personalize LCS is urgently needed.
Use LCS as a model to study how to deliver decision support to personalize screening in primary care settings.
Aim 1 - Assess informed stakeholder views (2 projects): The goal of this aim is to use democratic deliberation methods to extensively inform and engage key LCS stakeholders and elicit recommendations for practical approaches to personalizing LCS. First, I will recruit a "citizens jury" of 12-15 clinical stakeholders (PCPs and clinical leaders) from VA nationwide to provide recommendations on "boundary rules" for when screening should be encouraged, discouraged, or left wholly to l patient choice (project 1a). Then, I will recruit a random sample of up to 64 "VISN 10" Veterans (LCS-eligible) for a 6-8 hour "deliberation poll" (project 1b).
Aim 2 - Optimize decision support 'fit' with the VA clinical context (2 projects): First, I will conduct a mixed-methods "synthesis" analysis of ongoing tool implementation data (from a VA QUERI project I co-lead) to understand how LCS decision support can be redesigned to overcome implementation challenges and enhance motivators for tool use (project 2a). Then, I survey clinical stakeholders to: 1) evaluate novel decision support content and design strategies; 2) contribute new ideas; and 3) prioritize strategies and content for an upgraded tool (project 2b).
Aim 3 - Pilot (2 projects): Conduct a real-world pilot test of a novel decision tool to improve LCS decisions.
Not yet available.
This research will help PCPs and their teams address national guidelines for offering LCS, while also informing how decisions for similar substantive, high-volume interventions can be personalized in primary care.
- Rivera MP, Tanner NT, Silvestri GA, Detterbeck FC, Tammemägi MC, Young RP, Slatore CG, Caverly TJ, Boyd CM, Braithwaite D, Fathi JT, Gould MK, Iaccarino JM, Malkoski SP, Mazzone PJ, Tanoue LT, Schoenborn NL, Zulueta JJ, Wiener RS, American Thoracic Society Assembly on Thoracic Oncology. Incorporating Coexisting Chronic Illness into Decisions about Patient Selection for Lung Cancer Screening. An Official American Thoracic Society Research Statement. American journal of respiratory and critical care medicine. 2018 Jul 15; 198(2):e3-e13.
- Caverly TJ, Cao P, Hayward RA, Meza R. Identifying Patients for Whom Lung Cancer Screening Is Preference-Sensitive: A Microsimulation Study. Annals of internal medicine. 2018 Jul 3; 169(1):1-9.
- Markovitz AA, Hofer TP, Froehlich W, Lohman SE, Caverly TJ, Sussman JB, Kerr EA. An Examination of Deintensification Recommendations in Clinical Practice Guidelines: Stepping Up or Scaling Back? JAMA internal medicine. 2018 Mar 1; 178(3):414-416.
- Sakoda LC, Henderson LM, Caverly TJ, Wernli KJ, Katki HA. Applying Risk Prediction Models to Optimize Lung Cancer Screening: Current Knowledge, Challenges, and Future Directions. Current epidemiology reports. 2017 Dec 1; 4(4):307-320.