Lung cancer is a leading cause of cancer death in the United States, with an estimated 161,840 deaths in 2008. The popularity and availability of lung cancer screening has increased in the United States, despite controversy between advocates of screening and those who believe the efficacy of screening is unproven. There has been extensive media coverage of CT screening trials such as the I-ELCAP, NLST and NELSON trials. In addition, there has been media coverage of new screening methodologies such as genetic and lung serum testing. Nevertheless, there is no agreement on whether screening will reduce lung cancer mortality, and screening carries risks. As screening procedures become better known and more widely available, more individuals will face difficult decisions about whether to be screened for lung cancer and by what method. For such situations, informed decision making is critical, but little is currently known about what factors are important to individuals in making decisions about lung cancer screening. The long term goal of this line of research is to develop an informed decision making aid for lung cancer screening among asymptomatic high risk individuals. The specific objective of this application is to develop and explore a conjoint survey instrument that can be used to collect information on screening attributes that affect decisions about lung cancer screening. The conjoint methodology is an innovative approach to preference elicitation and its use in health care research has been increasing in recent years. The primary aims of this research are to: (1) Determine the range of process and outcome attributes of lung cancer screening that affect interest in being screened for lung cancer and develop and pilot test a conjoint survey instrument to evaluate these attributes;(2) Determine the importance and utility of each of the lung cancer screening scenario attributes;and (3) Determine the association of individual characteristics with interest in screening. To accomplish these aims we will first conduct semi-structured interviews with the target population and health care providers to gain information on the attributes of various lung cancer screening examinations that are important in individuals'screening decisions. We will use Sawtooth Software to develop a conjoint survey instrument and compile a survey which also includes various individual characteristics that also may be associated with screening interest. We will pilot test this survey using cognitive interviewing techniques, and then conduct a preliminary survey via a nationally representative web-based survey. The survey instrument developed in this research will then be used in future research which will have as its aim the development of a lung cancer decision aid that can be tailored to individual characteristics. The conjoint instrument will be an essential part of the decision aid as it helps individuals focus their preferences and facilitates decision making in complex, multi-attribute situations.
Lung cancer will lead to over 160,000 deaths in the United States in 2008. Screening for lung cancer may have the potential to shift diagnoses to an earlier stage where cancer is more treatable. However, given the uncertainty of screening benefits and significant risks, patient centered informed decision making about screening is critical. This research will allow us to develop an individually-tailored informed decision making aid to promote informed decision making about lung cancer screening, and lead to improvements in patient satisfaction and welfare.
