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Health Services Research & Development

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HSR&D In Progress

February 2018

In this Issue: Improving Cancer Care
» Table of Contents

Incorporating Veterans’ Preferences into Lung Cancer Screening Decisions

Feature Article

Clinical guidelines have been issued with the United States Preventive Services Task Force (USPSTF) recommending annual lung cancer screening from age 55 to 80 to those with >30 pack years of smoking who continue to smoke or have quit less than 15 years ago. VA conducted a clinical demonstration project at eight VA hospitals to gain insight into the practice and outcomes of lung cancer screening in the Veteran population. Evidence clearly delineates both the benefits (mortality reduction) and harms (i.e., false positives, follow-up testing, and over-diagnosis) of screening, and it suggested that a comprehensive lung cancer screening program would be a complex and challenging undertaking. Preference assessment methods could help Veterans to weigh benefits and harms, consider the clinical pathway they are entering, anticipate future health states, and communicate these values to health care providers.

This ongoing study (2017-2020) is eliciting stakeholder input to inform the development of a lung cancer screening decision tool (LCSDecTool). Investigators are interviewing focus groups that include patients, providers, and clinical leaders to explore:

  • The patient perspective regarding:
  • Desired content and format of the LCSDecTool,
  • Facilitators and barriers to use of a LCSDecTool in the primary care setting, and
  • Acceptability of web-based technology for lung cancer screening decision support.
  • The provider perspective regarding:
    • Evidence of benefit for lung cancer screening decision support,
    • Attitudes towards implementing lung cancer screening decision support in the primary care setting, and
    • Acceptability of web-based technology for lung cancer screening decision support.
  • The clinical leaders perspective regarding:
    • Feasibility of integrating the LCSDecTool into clinical practice, and
    • Training and support needed for use of the LCSDecTool in practice setting.

Study investigators will then develop a web-based LCSDecTool that incorporates findings from the focus groups. The tool will expand existing materials available for Veterans through a web application that can be used on a desktop, laptop, tablet, or mobile phone. Investigators also will conduct a randomized controlled trial to evaluate the efficacy of the LCSDecTool, as well as feasibility and process outcomes to support wide-spread implementation.


Results from this study are expected to help VA expand the use of web-based decision support tools for early cancer detection through screening, which significantly increases the odds for optimal care and outcomes for Veterans.

Principal Investigator:  Marilyn Schapira, MD, MPH, HSR&D’s Center for Health Equity Research & Promotion (CHERP), Philadelphia, PA.

Incorporating Veterans’ Preferences into Lung Cancer Screening Decisions project abstract


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