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Veterans’ Identification of Important Factors in Lung Cancer Screening Decision Making.

Fu SS, Fabrin A, Rice K, Bangerter AK, Clothier BA, Do TM, Doro EA, Moughrabieh A, Nelson DB, Partin MR, Lillie SE. Veterans’ Identification of Important Factors in Lung Cancer Screening Decision Making. Presented at: Preventing Overdiagnosis Annual Conference; 2015 Sep 1; Bethesda, MD.

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Objectives We identified factors Veterans at the Minneapolis VA considered most important in lung cancer screening (LCS) decision making, and examined variation by LCS participation and Veteran characteristics. Methods In 2014 the Veterans Health Administration initiated a LCS Clinical Demonstration Project, offering LCS CT to eligible Veterans. We surveyed Veterans 3 months after LCS invitation to assess their perceptions about the importance (1 = 'not at all important' to 5 = 'extremely important') of 8 factors: lung cancer risk, fear of getting lung cancer, chance of incidental findings, LCS convenience, chance of false positive result, anxiety waiting for LCS results, knowledge about LCS, and CT scan health risks. We compared mean ratings across various subgroups. Results Of 877 Veterans invited to LCS, 43.8% completed the survey (N = 384). Overall, the factor rated most important to LCS decision making was lung cancer risk (mean 3.26) and least important was CT scan health risks (2.35). Compared to the 70% of survey responders who did not schedule a LCS CT (N = 269), the 30% who did (N = 115) rated the following as more important: lung cancer risk (3.48vs3.16,p < 0.01), fear of getting lung cancer (3.42vs3.05,p < 0.01), chance of incidental findings (3.22vs2.99,p < 0.05); they rated CT scan health risks as less important (2.10vs2.46,p < 0.01). Current smokers rated the fear of getting lung cancer as more important than ex-smokers (3.31vs3.05,p < 0.05), participants with more than a high school education rated LCS knowledge as more important than those less educated (2.87vs2.58,p < 0.05), and participants with an income < = $40,000 rated the convenience of LCS as more important than those with an income > $40,000 (3.21vs2.91,p < 0.05). Conclusions Factors identified as important in LCS decision making varied with Veteran characteristics, but mainly focused on the benefits of LCS. As LCS is implemented widely, these findings suggest a need to inform patients of potential screening harms and support the development of targeted decision tools.

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