An Alternating-intervention Pilot Trial on the Impact of an Informational Handout on Patient-reported Outcomes and Follow-up After Lung Cancer Screening

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2024 Apr 10

PMID 38598511

Authors

Matthew Triplette

Erin K Kross

Madison Snidarich

Shahida Shahrir

Daniel S Hippe

Kristina Crothers

Affiliations

Soon will be listed here.

Abstract

Introduction: Lung cancer screening (LCS) can reduce lung cancer mortality; however, poor understanding of results may impact patient experience and follow-up. We sought to determine whether an informational handout accompanying LCS results can improve patient-reported outcomes and adherence to follow-up.

Study Design: This was a prospective alternating intervention pilot trial of a handout to accompany LCS results delivery.

Setting/participants: Patients undergoing LCS in a multisite program over a 6-month period received a mailing containing either: 1) a standardized form letter of LCS results (control) or 2) the LCS results letter and the handout (intervention).

Intervention: A two-sided informational handout on commonly asked questions after LCS created through iterative mixed-methods evaluation with both LCS patients and providers.

Outcome Measures: The primary outcomes of 1)patient understanding of LCS results, 2)correct identification of next steps in screening, and 3)patient distress were measured through survey. Adherence to recommended follow-up after LCS was determined through chart review. Outcomes were compared between the intervention and control group using generalized estimating equations.

Results: 389 patients were eligible and enrolled with survey responses from 230 participants (59% response rate). We found no differences in understanding of results, identification of next steps in follow-up or distress but did find higher levels of knowledge and understanding on questions assessing individual components of LCS in the intervention group. Follow-up adherence was overall similar between the two arms, though was higher in the intervention group among those with positive findings (p = 0.007).

Conclusions: There were no differences in self-reported outcomes between the groups or overall follow-up adherence. Those receiving the intervention did report greater understanding and knowledge of key LCS components, and those with positive results had a higher rate of follow-up. This may represent a feasible component of a multi-level intervention to address knowledge and follow-up for LCS.

Trial Registration: ClinicalTrials.gov NCT05265897.

References

Smith H, Schneider E, Tanner N . An Evaluation of Annual Adherence to Lung Cancer Screening in a Large National Cohort. Am J Prev Med. 2022; 63(2):e59-e64. DOI: 10.1016/j.amepre.2022.01.016. View

Sessler D, Myles P . Novel Clinical Trial Designs to Improve the Efficiency of Research. Anesthesiology. 2019; 132(1):69-81. DOI: 10.1097/ALN.0000000000002989. View

Melzer A, Golden S, Ono S, Datta S, Crothers K, Slatore C . What Exactly Is Shared Decision-Making? A Qualitative Study of Shared Decision-Making in Lung Cancer Screening. J Gen Intern Med. 2019; 35(2):546-553. PMC: 7018920. DOI: 10.1007/s11606-019-05516-3. View

Slatore C, Wiener R, Laing A . What is a Lung Nodule?. Am J Respir Crit Care Med. 2016; 193(7):P11-2. DOI: 10.1164/rccm.1937P11. View

Freiman M, Clark J, Slatore C, Gould M, Woloshin S, Schwartz L . Patients' Knowledge, Beliefs, and Distress Associated with Detection and Evaluation of Incidental Pulmonary Nodules for Cancer: Results from a Multicenter Survey. J Thorac Oncol. 2016; 11(5):700-708. PMC: 4851914. DOI: 10.1016/j.jtho.2016.01.018. View

Sakoda L, Rivera M, Zhang J, Perera P, Laurent C, Durham D . Patterns and Factors Associated With Adherence to Lung Cancer Screening in Diverse Practice Settings. JAMA Netw Open. 2021; 4(4):e218559. PMC: 8087957. DOI: 10.1001/jamanetworkopen.2021.8559. View

Barrett S, Patrie J, Kitts A, Hanley M, Swanson C, Vitzthum von Eckstaedt H . Patient-centered Reporting in Radiology: A Single-site Survey Study of Lung Cancer Screening Results. J Thorac Imaging. 2021; 36(6):367-372. DOI: 10.1097/RTI.0000000000000591. View

Mazzone P, Tenenbaum A, Seeley M, Petersen H, Lyon C, Han X . Impact of a Lung Cancer Screening Counseling and Shared Decision-Making Visit. Chest. 2016; 151(3):572-578. DOI: 10.1016/j.chest.2016.10.027. View

Crothers K, Shahrir S, Kross E, Kava C, Cole A, Wenger D . Patient and Clinician Recommendations to Improve Communication and Understanding of Lung Cancer Screening Results. Chest. 2022; 163(3):707-718. DOI: 10.1016/j.chest.2022.09.038. View

10.

Fioratti I, Santos V, Fernandes L, Rodrigues K, Soares R, Saragiotto B . Translation, cross-cultural adaptation and measurement properties of three implementation measures into Brazilian-Portuguese. Arch Physiother. 2023; 13(1):7. PMC: 10041794. DOI: 10.1186/s40945-023-00160-x. View

11.

Aberle D, Adams A, Berg C, Black W, Clapp J, Fagerstrom R . Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011; 365(5):395-409. PMC: 4356534. DOI: 10.1056/NEJMoa1102873. View

12.

Kurz A, Kopyeva T, Suliman I, Podolyak A, You J, Lewis B . Supplemental oxygen and surgical-site infections: an alternating intervention controlled trial. Br J Anaesth. 2018; 120(1):117-126. DOI: 10.1016/j.bja.2017.11.003. View

13.

Kim R, Rendle K, Mitra N, Saia C, Neslund-Dudas C, Greenlee R . Racial Disparities in Adherence to Annual Lung Cancer Screening and Recommended Follow-Up Care: A Multicenter Cohort Study. Ann Am Thorac Soc. 2022; 19(9):1561-1569. PMC: 9447384. DOI: 10.1513/AnnalsATS.202111-1253OC. View

14.

Chelala L, Hossain R, Kazerooni E, Christensen J, Dyer D, White C . Lung-RADS Version 1.1: Challenges and a Look Ahead, From the Special Series on Radiology Reporting and Data Systems. AJR Am J Roentgenol. 2021; 216(6):1411-1422. DOI: 10.2214/AJR.20.24807. View

15.

Kunitomo Y, Bade B, Gunderson C, Akgun K, Brackett A, Cain H . Racial Differences in Adherence to Lung Cancer Screening Follow-up: A Systematic Review and Meta-analysis. Chest. 2021; 161(1):266-275. DOI: 10.1016/j.chest.2021.07.2172. View

16.

Weiner B, Lewis C, Stanick C, Powell B, Dorsey C, Clary A . Psychometric assessment of three newly developed implementation outcome measures. Implement Sci. 2017; 12(1):108. PMC: 5576104. DOI: 10.1186/s13012-017-0635-3. View

17.

Hofmann G, Hampanda K, Harrison M, Fasano M, Nacht A, Yeoman M . Virtual Prenatal and Postpartum Care Acceptability Among Maternity Care Providers. Matern Child Health J. 2022; 26(7):1401-1408. PMC: 8923334. DOI: 10.1007/s10995-022-03412-7. View

18.

Nunez E, Caverly T, Zhang S, Glickman M, Qian S, Boudreau J . Adherence to Follow-up Testing Recommendations in US Veterans Screened for Lung Cancer, 2015-2019. JAMA Netw Open. 2021; 4(7):e2116233. PMC: 8267608. DOI: 10.1001/jamanetworkopen.2021.16233. View

19.

Tammemagi M, Katki H, Hocking W, Church T, Caporaso N, Kvale P . Selection criteria for lung-cancer screening. N Engl J Med. 2013; 368(8):728-36. PMC: 3929969. DOI: 10.1056/NEJMoa1211776. View

20.

Triplette M, Wenger D, Shahrir S, Kross E, Kava C, Phipps A . Patient Identification of Lung Cancer Screening Follow-Up Recommendations and the Association with Adherence. Ann Am Thorac Soc. 2021; 19(5):799-806. DOI: 10.1513/AnnalsATS.202107-887OC. View