Impact of recruitment method on informed decision-making in lung cancer screening in the 4-IN-THE-LUNG-RUN trial

Abstract

Objectives: It is relatively unknown how to inform individuals about lung cancer screening to enable informed decision-making (IDM). This study aims to determine the level of IDM across different recruitment methods among participants invited for the 4-IN-THE-LUNG-RUN trial, the European implementation trial for lung cancer screening.

Methods: A 23-item online questionnaire related to decision-relevant knowledge was sent to 848 Dutch men and women, aged 60-79 years, who were randomised in 4-IN-THE-LUNG-RUN. Respondents were considered to have sufficient knowledge when answering at least 12 items correctly. Informed choice was determined as 1) having sufficient knowledge and 2) consistency between intention to be screened and actual participation.

Results: Participants were recruited between July 2024 and August 2024. Of 386 respondents (45.5 %) with fully completed questionnaires, 327 (84.7 %) had sufficient knowledge and made an informed decision, 283 (85.2 %) of the screened participants (n = 332) did so. Knowledge scores increased with the level of tailoring as compared to standard paper information (p = 0.015). While 78.1 % from the standard paper group made an informed choice, 89.0 % from the tailored group did so (p = 0.088). IDM was comparable among the socioeconomic status (SES) groups: 79.8 % (95/119) of the participants in the lower, 84.5 % (93/110) in the middle, and 88.5 % (139/157) in the high SES group made an informed decision (p = 0.138). No sex-related differences were found in informed decision-making: 196 out of 231 males (84.8 %) versus 131 out of 155 females (84.5 %), p = 0.929. Even if assumed that all responders with incomplete questionnaires did have insufficient knowledge, 69.6 % were able to make an informed decision.

Conclusion: The manner in which participants are informed contributes to the extent to which they can make an informed decision. A more tailored approach leads to improved knowledge, which facilitates IDM. The results indicate an equivalent level of IDM across different SES and sex groups.

Keywords: Early detection of cancer; Health communication; Informed choice; Informed decision-making; Lung cancer screening; Recruitment.