# Incorporating Veterans' Preferences into Lung Cancer Screening Decisions

> **NIH VA I01** · PHILADELPHIA VA MEDICAL CENTER · 2020 · —

## Abstract

Lung cancer is the leading cause of cancer deaths in the United States. Recent clinical trials provide evidence
that screening with low dose CT scans will decrease lung cancer and all cause mortality among older heavy
smokers. Clinical guidelines have been issued with the USPSTF recommending annual screening from age 55
to 80 for those with 30 pack years or more of smoking or who quit less than 15 years ago. Evidence clearly
delineates both the benefits (mortality reduction) and harms (false positives, follow-up testing, risk of invasive
testing, and risk of overdiagnosis) of lung cancer screening. Preliminary data from an HSR&D pilot grant finds
that some Veterans are highly reluctant to enter the care pathway associated with lung cancer screening due
to its potential harms. Additional preliminary data using Best Worst Scaling in older smokers demonstrate
groups of patients who place greater importance on harms than benefit when considering lung cancer
screening. Preference assessment methods can help Veterans to weigh benefits and harms, consider the
clinical pathway they are entering, anticipate future health states, and communicate these values to their health
care providers. Although basic educational tools to inform lung cancer decision-making have been developed,
there is a lack of validated preference assessment tools that can be integrated into the clinical setting. Building
upon preference assessment methods developed and validated in an HSR&D pilot grant (PI-Schapira) and
using a trans-disciplinary approach, this team is positioned to advance the science and practice of decision
support for lung cancer screening in the Veteran population. The objectives of this study are to 1) elicit
patient and provider stakeholder input to inform the development of a lung cancer screening decision tool, 2)
develop a web based Lung Cancer Screening Decision Tool (LCSDecTool) that incorporates patient and
provider input, and 3) evaluate the impact of the LCSDecTool compared to usual care on the decision process,
clinical outcomes, and quality of life. The study will be conducted in 3 phases. In phase 1, mixed methods will
be used to assess usability of preference assessment methods and perceived usefulness of a web based lung
cancer screening decision support tool among patient and provider stakeholders. In phase 2, an interactive
web based decision support program will be developed that incorporates preference assessment methods. In
phase 3, a pilot RCT will be conduced to evaluate the efficacy of the web based decision support program.
Outcomes evaluated will include decision quality as indicated by knowledge, decisional conflict, and decision
regret; screening behavior, clinical outcomes as indicated by anxiety, and quality of life. The study will be
conducted across two VA sites; West Haven-VA in Connecticut and Corporal Michael J. Crescenz VA in
Philadelphia, Pennsylvania. Results of this study will provide tools that can be used to integrate lung...

## Key facts

- **NIH application ID:** 9768210
- **Project number:** 5I01HX001898-03
- **Recipient organization:** PHILADELPHIA VA MEDICAL CENTER
- **Principal Investigator:** MARILYN M SCHAPIRA
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2017-03-01 → 2021-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9768210

## Citation

> US National Institutes of Health, RePORTER application 9768210, Incorporating Veterans' Preferences into Lung Cancer Screening Decisions (5I01HX001898-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9768210. Licensed CC0.

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