# Implementing Shared Decision-Making for Cancer Screening in Primary Care

> **NIH VA IK2** · VETERANS HEALTH ADMINISTRATION · 2022 · —

## Abstract

Even more than other screening services, it is difficult to know which patients are most likely to benefit
from lung cancer screening (LCS). More difficult yet is explaining to patients the trade-offs of screening for
them personally, particularly when time for discussing preventive services is limited to less than 5 minutes
during a busy visit. Decision support can help, but must contain 3 key features to be maximally effective and
sustainable: 1) communication of accurate estimates of the benefit of LCS for an individual patient; 2) design
and content that incorporates the values and concerns of informed stakeholders (clinicians, VA leaders, and
Veterans) and a practical approach to routinely personalizing screening during busy clinic visits; and 3) design
that optimizes the tool’s fit with VA clinical workflows. In collaboration with my mentors and steering committee,
I propose to carry out work that will leverage and substantially build on a project I am co-leading – Ann Arbor
VA’s funded PROVE QUERI – which studies expeditious implementation of a more traditional shared decision-
making (SDM) tool equipped with only the first feature (individualized estimates of LCS benefit). To achieve
these goals the CDA has 3 aims.
 Aim 1 – Assess informed stakeholder views (3 projects): In this aim I will use democratic deliberation
to extensively inform and engage key LCS stakeholders to understand their opinions/recommendations about
offering and discussing LCS. In project 1a (“Clinical Forum”) I will recruit a group of 12-15 clinical stakeholders
(PCPs, screening coordinators, and clinical leaders) from VA nationwide to inform them of the heterogeneity of
LCS benefit and engage them in deliberation, obtaining their recommendations for “simple boundary rules” for
when screening should be encouraged, discouraged, or left wholly to l patient choice. In project 1b (2 “Veteran
Forums”) I will recruit a random sample of up to 64 VISN 10 Veterans who are LCS-eligible and conduct 2
separate daylong forums. The core objective will be to utilize 2 content experts with differing viewpoints to
inform Veterans about the challenges of LCS implementation and the constraints of clinical practice, and then
to obtain individual and group recommendations for “simple how-to rules” clinicians can use to involve patients
in LCS discussions given the competing demands PCPs face. In project 1c I will use risk communication theory
to develop innovative new tool features that incorporate the VA Stakeholder guidance and can help guide
clinicians in how to efficiently personalize LCS.
 Aim 2 – Optimize decision support ‘fit’ with the VA clinical context (2 projects): In project 2a I will
conduct a synthesis analysis of multiple streams of PROVE QUERI data to understand how LCS decision
support can be redesigned to overcome implementation challenges and enhance motivators for tool use. Then,
in project 2b I explore wiki surveys as a new method of engaging clinical stakeholders to...

## Key facts

- **NIH application ID:** 10424429
- **Project number:** 5IK2HX002246-05
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** TANNER J CAVERLY
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-04-01 → 2023-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10424429

## Citation

> US National Institutes of Health, RePORTER application 10424429, Implementing Shared Decision-Making for Cancer Screening in Primary Care (5IK2HX002246-05). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10424429. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*