Supporting community translation of lung cancer screening: A web-based decision aid to support informed decision making

Background: Results of the National Lung Screening Trial create the potential to reduce lung cancer mortality, but community translation of lung cancer screening (LCS) has been challenging. Subsequent policies have endorsed informed and shared decision-making and using decision support tools to support person-centered choices about screening to facilitate implementation. This study evaluated the feasibility and acceptability of LuCaS CHOICES, a web-based decision aid to support delivery of accurate information, facilitate communication skill development, and clarify personal preferences regarding LCS-a key component of high-quality LCS implementation. Methods: Using a parallel groups randomized trial, the study investigated the feasibility and acceptability of LuCaS CHOICES decision aid in comparison to the National Cancer Institute's Lung Cancer Screening website. Three waves of self-report data were collected: baseline (PRE), 2 weeks post-baseline (POST), and 4 months post-baseline (FOL). Participant accrual and intervention access data were also collected to evaluate methodological feasibility for conducting a larger subsequent trial. Results: Participants assigned to LuCaS CHOICES (n = 25) and the NCI website (n = 25) interventions reported similar, favorable levels of intervention feasibility and acceptability that exceeded a priori criteria. Methodological feasibility was partially supported for the proposed accrual and retention goals, but accrual was slower than hypothesized, and documented exposure to the digital interventions was suboptimal per a priori standards. Conclusions: Overall, both interventions demonstrated intervention feasibility and acceptability. In addition, the proposed methods achieved desired levels of retention and overall data collection. Modifications to enhance intervention engagement should be explored prior to further testing. Subsequent steps involve conducting a randomized clinical trial to evaluate the effect of LuCaS CHOICES on informed decision making and preference-concordant screening behavior, supporting LCS translation into community settings. A novel lung cancer screening decision aid (LuCaS CHOICES) was acceptable to screening candidates and a feasible approach to supporting preference-concordant decision making about participating in lung cancer screening. Lung cancer screening (LCS) is an evidence-based and policy-supported screening modality that holds tremendous potential to reduce lung cancer mortality. Every authoritative organization has endorsed and emphasized the importance of informed and shared decision-making efforts in the implementation of LCS. The lung cancer screening decision aid (LuCaS) CHOICES is a web-based decision aid designed to support informed decision-making about LCS among individuals at higher risk of lung cancer. Using a randomized trial design, the study compared the feasibility and acceptability of the LuCaS CHOICES decision aid against the NCI website designed to educate the public about LCS. Results showed that LuCaS CHOICES and the NCI website were comparably feasible and acceptable to participants, but that some of the methods used to study these interventions could be improved to support effective accrual and intervention delivery. Informed by study results, future research will pursue additional evaluation of LuCaS CHOICES efficacy and effectiveness and assess the impact of LuCaS CHOICES in supporting translation of high quality, preference-concordant LCS into community settings.