Lung cancer is the leading cause of cancer-related death in the US, and smoking cessation is the main modifiable risk factor for lung cancer. In 2011 the National Lung Screening Trial (NLST), a large multicenter randomized controlled trial, found that screening for lung cancer using a special type of lung scanning called low dose CT scanning resulted in lower rate of lung cancer deaths among current and former smokers screened with low dose computed tomography (LDCT) compared to chest x-rays. This was the first high- quality study to prove that screening can prevent death from lung cancer. Based on these findings, specialty groups have now recommended that screening with LDCT be offered to at-risk patients. However, concerns have been raised about the potential adverse consequences of widespread screening including: a) whether screening could discourage current smokers from quitting by providing false reassurance;and b) whether patients can be informed about the potential benefits and potential harms associated with screening. This issue is of particular concern for patient populations with limited health literacy. Informed decision-making is critical because screening identifies a large number of benign lung nodules ("false positives") that require further testing and procedures. This can put patients at risk of harms they may not have experienced had screening not been performed. Our objective is to develop an informed decision making tool for use in counseling patients who are potentially "eligible" for lung cancer screening. First, we will convene an expert panel to help us develop candidate messages for the tool. Second, conduct focus groups of patients who are current smokers and who are either eligible for lung cancer screening or have had an LDCT screening test in order to get their perspectives on these messages and help us improve them. We will also ask them how thinking about getting screened for lung cancer might also help them decide to attempt to quit smoking. Third, we will interview physicians to learn how they would use the tool to counsel patients about screening and smoking cessation in practice. Next, we will refine the tool by interviewing individual patients (not in a group) to us make sure the final messages are clear. Finally, we'll conduct physician-patient "role plays" to test out the final decision making tool an to see how long it takes to deliver. With its focus on smoking and cancer screening, the proposed research is highly relevant to the prevention objectives of the Centers for Disease Control and the National Center for Chronic Disease Prevention and Health Promotion. It will result in a tool that is ready to be tested in a clinical trial. The trial will test whether this tol can effectively promote informed decision-making and smoking cessation in practice. .

Public Health Relevance

Lung cancer screening with low dose computed tomography (LDCT) has now been shown to reduce lung cancer mortality in high risk individuals. However, it is unclear how to ensure patients are adequately informed about the potential for both benefits and harms from screening, particularly in patients with limited health literacy. We propose to develop an informed decision making tool to help doctors promote informed decision making about LDCT screening and smoking cessation. Promoting appropriate use of LDCT screening and reduction in lung cancer risk through smoking cessation are important public health priorities.

Agency
National Institute of Health (NIH)
Institute
National Center for Chronic Disease Prev and Health Promo (NCCDPHP)
Type
Health Promotion and Disease Prevention Research Centers (U48)
Project #
3U48DP001944-05S1
Application #
8642288
Study Section
Special Emphasis Panel (ZDP1-EEO (7C))
Project Start
2009-09-30
Project End
2014-09-29
Budget Start
2013-09-30
Budget End
2014-09-29
Support Year
5
Fiscal Year
2013
Total Cost
$2,084,080
Indirect Cost
$454,028
Name
University of North Carolina Chapel Hill
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
608195277
City
Chapel Hill
State
NC
Country
United States
Zip Code
27599
Erinosho, Temitope; Hales, Derek; Vaughn, Amber et al. (2016) Impact of Policies on Physical Activity and Screen Time Practices in 50 Child-Care Centers in North Carolina. J Phys Act Health 13:59-66
Schneider, Ellen C; Smith, Matthew Lee; Ory, Marcia G et al. (2016) State Fall Prevention Coalitions as Systems Change Agents: An Emphasis on Policy. Health Promot Pract 17:244-53
Davis, Nicole L; Miller, William C; Hudgens, Michael G et al. (2016) Maternal and Breastmilk Viral Load: Impacts of Adherence on Peripartum HIV Infections Averted-The Breastfeeding, Antiretrovirals, and Nutrition Study. J Acquir Immune Defic Syndr 73:572-580
Cavallo, David N; Sisneros, Jessica A; Ronay, Ashley A et al. (2016) Assessing the Feasibility of a Web-Based Weight Loss Intervention for Low-Income Women of Reproductive Age: A Pilot Study. JMIR Res Protoc 5:e30
Vaughn, Amber E; Ward, Dianne S; Fisher, Jennifer O et al. (2016) Fundamental constructs in food parenting practices: a content map to guide future research. Nutr Rev 74:98-117
Keyserling, Thomas C; Samuel-Hodge, Carmen D; Pitts, Stephanie Jilcott et al. (2016) A community-based lifestyle and weight loss intervention promoting a Mediterranean-style diet pattern evaluated in the stroke belt of North Carolina: the Heart Healthy Lenoir Project. BMC Public Health 16:732
Escoffery, Cam; Hannon, Peggy; Maxwell, Annette E et al. (2015) Assessment of training and technical assistance needs of Colorectal Cancer Control Program Grantees in the U.S. BMC Public Health 15:49
Friedman, Daniela B; Becofsky, Katie; Anderson, Lynda A et al. (2015) Public perceptions about risk and protective factors for cognitive health and impairment: a review of the literature. Int Psychogeriatr 27:1263-75
Ward, Dianne S; Mazzucca, Stephanie; McWilliams, Christina et al. (2015) Use of the Environment and Policy Evaluation and Observation as a Self-Report Instrument (EPAO-SR) to measure nutrition and physical activity environments in child care settings: validity and reliability evidence. Int J Behav Nutr Phys Act 12:124
Robbins, Cheryl L; Keyserling, Thomas C; Jilcott Pitts, Stephanie et al. (2015) Outcomes of cardiovascular disease risk factor screening and referrals in a family planning clinic. J Womens Health (Larchmt) 24:131-7

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