The quality of patient decision aids for lung cancer screening: Results from an environmental scan

Abstract

Shared decision making is recommended for lung cancer screening (LCS) by professional organizations and payers. Patient decision aids can be used to support shared decision making, but they need to meet quality standards to minimize the potential for biased and poorly informed patient decisions. After the updated LCS recommendation from the US Preventive Services Task Force in 2021, the authors conducted an environmental scan of public-facing patient educational materials and evaluated them against criteria from the International Patient Decision Aid Standards for high-quality patient decision aids. The Google site search function was used to search websites from National Cancer Institute-funded cancer centers, professional societies, patient advocacy groups, cancer coalitions, and private organizations for educational materials on LCS. A general web search using Google, Google Scholar, and select databases was also conducted. Considerations unique to the LCS context (e.g., the importance of annual screening and smoking cessation) were documented. The search identified 96 educational materials that included information about both benefits and harms of LCS. Of these, 39 did not meet qualifying criteria for decision aids, with failure to explicitly identify LCS as a decision being the primary reason for exclusion. Only 10 of the remaining decision aids met quality criteria from the International Patient Decision Aid Standards. These aids emphasized that LCS should be performed annually, most avoided stigmatizing language, and several included personalization features using prediction models. Clinicians and patients can be confident in using these high-quality aids to complement the process of shared decision making for LCS. Validated aids in languages other than English and Spanish are needed.

Keywords: cancer early detection; decision aids; lung neoplasms, patient education, shared decision making.

FIGURE 1

Modified PRISMA flowchart. IPDAS indicates International Patient Decision Aid Standards; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta‐Analyses.

FIGURE 2

Reasons tools failed to meet International Patient Decision Aid Standards‐qualifying criteria for decision aids.