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Prediction-Augmented Shared Decision-Making and Lung Cancer Screening Uptake.
- Source :
-
JAMA network open [JAMA Netw Open] 2024 Jul 01; Vol. 7 (7), pp. e2419624. Date of Electronic Publication: 2024 Jul 01. - Publication Year :
- 2024
-
Abstract
- Importance: Addressing poor uptake of low-dose computed tomography lung cancer screening (LCS) is critical, especially for those having the most to gain-high-benefit persons with high lung cancer risk and life expectancy more than 10 years.<br />Objective: To assess the association between LCS uptake and implementing a prediction-augmented shared decision-making (SDM) tool, which enables clinicians to identify persons predicted to be at high benefit and encourage LCS more strongly for these persons.<br />Design, Setting, and Participants: Quality improvement interrupted time series study at 6 Veterans Affairs sites that used a standard set of clinical reminders to prompt primary care clinicians and screening coordinators to engage in SDM for LCS-eligible persons. Participants were persons without a history of LCS who met LCS eligibility criteria at the time (aged 55-80 years, smoked ≥30 pack-years, and current smoking or quit <15 years ago) and were not documented to be an inappropriate candidate for LCS by a clinician during October 2017 through September 2019. Data were analyzed from September to November 2023.<br />Exposure: Decision support tool augmented by a prediction model that helps clinicians personalize SDM for LCS, tailoring the strength of screening encouragement according to predicted benefit.<br />Main Outcome and Measure: LCS uptake.<br />Results: In a cohort of 9904 individuals, the median (IQR) age was 64 (57-69) years; 9277 (94%) were male, 1537 (16%) were Black, 8159 (82%) were White, 5153 (52%) were predicted to be at intermediate (preference-sensitive) benefit and 4751 (48%) at high benefit, and 1084 (11%) received screening during the study period. Following implementation of the tool, higher rates of LCS uptake were observed overall along with an increase in benefit-based LCS uptake (higher screening uptake among persons anticipated to be at high benefit compared with those at intermediate benefit; primary analysis). Mean (SD) predicted probability of getting screened for a high-benefit person was 24.8% (15.5%) vs 15.8% (11.8%) for a person at intermediate benefit (mean absolute difference 9.0 percentage points; 95% CI, 1.6%-16.5%).<br />Conclusions and Relevance: Implementing a robust approach to personalized LCS, which integrates SDM, and a decision support tool augmented by a prediction model, are associated with improved uptake of LCS and may be particularly important for those most likely to benefit. These findings are timely given the ongoing poor rates of LCS uptake.
- Subjects :
- Humans
Aged
Male
Female
Middle Aged
Aged, 80 and over
Tomography, X-Ray Computed methods
Tomography, X-Ray Computed statistics & numerical data
United States
Interrupted Time Series Analysis
Quality Improvement
Lung Neoplasms diagnosis
Early Detection of Cancer methods
Early Detection of Cancer statistics & numerical data
Decision Making, Shared
Subjects
Details
- Language :
- English
- ISSN :
- 2574-3805
- Volume :
- 7
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- JAMA network open
- Publication Type :
- Academic Journal
- Accession number :
- 38949809
- Full Text :
- https://doi.org/10.1001/jamanetworkopen.2024.19624