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CDA 16-151 – HSR&D Study

Pre-Funded | New | Current | Completed | DRA | DRE | Portfolios/Projects | Centers | Career Development Projects
CDA 16-151
Implementing Shared Decision-Making for Cancer Screening in Primary Care
Tanner Caverly MD MPH
VA Ann Arbor Healthcare System, Ann Arbor, MI
Ann Arbor, MI
Funding Period: April 2018 - March 2023

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.


Journal Articles

  1. Kukhareva PV, Li H, Caverly TJ, Del Fiol G, Fagerlin A, Butler JM, Hess R, Zhang Y, Taft T, Flynn MC, Reddy C, Martin DK, Warner IA, Rodriguez-Loya S, Warner PB, Kawamoto K. Implementation of Lung Cancer Screening in Primary Care and Pulmonary Clinics: Pragmatic Clinical Trial of Electronic Health Record-Integrated Everyday Shared Decision-Making Tool and Clinician-Facing Prompts. Chest. 2023 Nov 1; 164(5):1325-1338.
  2. Núñez ER, Caverly TJ, Zhang S, Glickman ME, Qian SX, Boudreau JH, Miller DR, Slatore CG, Wiener RS. Factors Associated With Declining Lung Cancer Screening After Discussion With a Physician in a Cohort of US Veterans. JAMA Network Open. 2022 Aug 1; 5(8):e2227126.
  3. Kukhareva PV, Caverly TJ, Li H, Katki HA, Cheung LC, Reese TJ, Del Fiol G, Hess R, Wetter DW, Zhang Y, Taft TY, Flynn MC, Kawamoto K. Inaccuracies in electronic health records smoking data and a potential approach to address resulting underestimation in determining lung cancer screening eligibility. Journal of the American Medical Informatics Association : JAMIA. 2022 Apr 13; 29(5):779-788.
  4. Lowery J, Fagerlin A, Larkin AR, Wiener RS, Skurla SE, Caverly TJ. Implementation of a Web-Based Tool for Shared Decision-making in Lung Cancer Screening: Mixed Methods Quality Improvement Evaluation. JMIR human factors. 2022 Apr 1; 9(2):e32399.
  5. Núñez ER, Caverly TJ, Zhang S, Glickman ME, Qian SX, Boudreau JH, Miller DR, Wiener RS. Invasive Procedures and Associated Complications After Initial Lung Cancer Screening in a National Cohort of Veterans. Chest. 2022 Aug 1; 162(2):475-484.
  6. Reese TJ, Schlechter CR, Kramer H, Kukhareva P, Weir CR, Del Fiol G, Caverly T, Hess R, Flynn MC, Taft T, Kawamoto K. Implementing lung cancer screening in primary care: needs assessment and implementation strategy design. Translational behavioral medicine. 2022 Feb 16; 12(2):187-197.
  7. Caverly TJ, Skurla SE, Robinson CH, Zikmund-Fisher BJ, Hayward RA. The Need for Brevity During Shared Decision Making (SDM) for Cancer Screening: Veterans' Perspectives on an "Everyday SDM" Compromise. MDM policy & practice. 2021 Oct 26; 6(2):23814683211055120.
  8. Caverly TJ, Skurla SE, Klamerus ML, Sparks JB, Kerr EA, Hofer TP, Reed D, Damschroder LJ. Applying User-Centered Design to Develop Practical Strategies that Address Overuse in Primary Care. Journal of general internal medicine. 2022 Apr 1; 37(Suppl 1):57-63.
  9. Mazzone PJ, Silvestri GA, Souter LH, Caverly TJ, Kanne JP, Katki HA, Wiener RS, Detterbeck FC. Screening for Lung Cancer: CHEST Guideline and Expert Panel Report. Chest. 2021 Nov 1; 160(5):e427-e494.
  10. Mazzone PJ, Silvestri GA, Souter LH, Caverly TJ, Kanne JP, Katki HA, Wiener RS, Detterbeck FC. Executive Summary: Screening for Lung Cancer: Chest Guideline and Expert Panel Report. Chest. 2021 Nov 1; 160(5):1959-1980.
  11. Kawamoto K, Kukhareva PV, Weir C, Flynn MC, Nanjo CJ, Martin DK, Warner PB, Shields DE, Rodriguez-Loya S, Bradshaw RL, Cornia RC, Reese TJ, Kramer HS, Taft T, Curran RL, Morgan KL, Borbolla D, Hightower M, Turnbull WJ, Strong MB, Chapman WW, Gregory T, Stipelman CH, Shakib JH, Hess R, Boltax JP, Habboushe JP, Sakaguchi F, Turner KM, Narus SP, Tarumi S, Takeuchi W, Ban H, Wetter DW, Lam C, Caverly TJ, Fagerlin A, Norlin C, Malone DC, Kaphingst KA, Kohlmann WK, Brooke BS, Del Fiol G. Establishing a multidisciplinary initiative for interoperable electronic health record innovations at an academic medical center. JAMIA open. 2021 Jul 1; 4(3):ooab041.
  12. Boudreau JH, Miller DR, Qian S, Nunez ER, Caverly TJ, Wiener RS. Access to Lung Cancer Screening in the Veterans Health Administration: Does Geographic Distribution Match Need in the Population? Chest. 2021 Jul 1; 160(1):358-367.
  13. Lau YK, Bhattarai H, Caverly TJ, Hung PY, Jimenez-Mendoza E, Patel MR, Coté ML, Arenberg DA, Meza R. Lung Cancer Screening Knowledge, Perceptions, and Decision Making Among African Americans in Detroit, Michigan. American journal of preventive medicine. 2021 Jan 1; 60(1):e1-e8.
  14. Leishman NJ, Wiener RS, Fagerlin A, Hayward RA, Lowery J, Caverly TJ. Variation in Eligible Patients' Agreeing to and Receiving Lung Cancer Screening: A Cohort Study. American journal of preventive medicine. 2021 Apr 1; 60(4):520-528.
  15. Caverly TJ, Zhang X, Hayward RA, Zhu J, Waljee AK. Effects of Random Measurement Error on Lung Cancer Screening Decisions: A Retrospective Cohort-Based Microsimulation Study. Chest. 2021 Feb 1; 159(2):853-861.
  16. Caverly TJ, Hayward RA. Dealing with the Lack of Time for Detailed Shared Decision-making in Primary Care: Everyday Shared Decision-making. Journal of general internal medicine. 2020 Oct 1; 35(10):3045-3049.
  17. Caverly TJ, Robinson CH, Krein SL, Forman J, Quinn M, Skurla SE, Damschroder L. Using Democratic Deliberation to Engage Veterans in Complex Policy Making for the Veterans Health Administration. Federal practitioner : for the health care professionals of the VA, DoD, and PHS. 2020 Jan 1; 37(1):24-32.
  18. Klamerus ML, Damschroder LJ, Sparks JB, Skurla SE, Kerr EA, Hofer TP, Caverly TJ. Developing Strategies to Reduce Unnecessary Services in Primary Care: Protocol for User-Centered Design Charrettes. JMIR research protocols. 2019 Nov 26; 8(11):e15618.
  19. Caverly TJ, Hayward RA, Burke JF. Much to do with nothing: microsimulation study on time management in primary care. BMJ (Clinical research ed.). 2018 Dec 13; 363:k4983.
  20. Caverly TJ, Hayward RA, Meza R. Identifying Patients for Whom Lung Cancer Screening Is Preference-Sensitive. Annals of internal medicine. 2018 Dec 4; 169(11):823.
  21. Dibble ER, Iott BE, Flynn AJ, King DP, MacEachern MP, Friedman CP, Caverly TJ. A Rapid Process for Identifying and Prioritizing Technology-Based Tools for Health System Implementation. JMIR cancer. 2018 Nov 27; 4(2):e11195.
  22. Wallace BI, Waljee AK, Weissman A, Caverly TJ, Saini SD. Overuse of glucocorticoids in rheumatoid arthritis: a national survey of primary care physicians. Rheumatology advances in practice. 2018 Nov 23; 3(1):rky049.
  23. 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.
  24. 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.
  25. 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.
  26. 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.
Journal Other

  1. Wiener RS, Barker AM, Carter-Harris L, Caverly TJ, Crocker DA, Denietolis A, Doherty C, Fagerlin A, Gallagher-Seaman M, Gould MK, Han PKJ, Herbst AN, Ito Fukunaga M, McCullough MB, Miano DA, Quaife SL, Slatore CG, Fix GM. Stakeholder Research Priorities to Promote Implementation of Shared Decision-Making for Lung Cancer Screening: An American Thoracic Society and Veterans Affairs Health Services Research and Development Statement. [Abstract]. American journal of respiratory and critical care medicine. 2022 Mar 15; 205(6):619-630.

DRA: Health Systems, Cancer
DRE: TRL - Applied/Translational, Treatment - Implementation
Keywords: none
MeSH Terms: none

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