# Achieving appropriate, safe, and patient-centered lung cancer screening

> **NIH VA I01** · EDITH NOURSE  ROGERS MEMORIAL VETERANS HOSPITAL · 2020 · —

## Abstract

Background: Lung cancer screening (LCS) reduces lung cancer death, but can also cause harm, especially
when applied to patients with co-existing serious health problems. Recognizing these trade-offs, guidelines
recommend that persons with “a health problem that substantially limits life expectancy or ability to have
curative lung surgery” should not be screened, and that all patients considering LCS should undergo a shared
decision-making (SDM) process to review LCS benefits and harms with their clinicians. Yet these
recommendations are difficult to achieve, as there is little evidence to guide clinicians on which health
problems or other patient factors tip the balance of LCS from net benefit to net harm, and little is known about
Veteran and clinician approaches to and needs for LCS decision-making when anticipated benefit is marginal.
Objectives: We propose a sequential explanatory mixed methods study with the following 3 specific aims:
1. Identify factors that predict little LCS benefit due to limited life expectancy or increased LCS harms;
2. Identify clinical patient factors associated with real-world clinician and Veteran LCS decisions; and
3. Characterize approaches to and needs for decision-making when predicted LCS benefit is marginal.
Methods: Aim 1a. To determine when competing (non-lung cancer) causes of death limit LCS benefit, we will
conduct a survival analysis among LCS-eligible but unscreened Veterans, building a competing risks model
and applying recursive partitioning to identify clinically meaningful risk groups. Aim 1b. We will build a model to
identify combinations of patient factors that predict complications of invasive procedures for LCS-detected
findings. Aim 2: We will compare how well factors associated with actual LCS decisions align with factors that
predict little LCS benefit (Aim 1 models), using data from 10 VA sites that tracked rates at which LCS-eligible
Veterans were deemed “too sick” for LCS, were offered LCS, and accepted LCS. We will build mixed effects
logistic regression models to complete these subaims: 2a-Identify patient factors associated with clinicians
deeming Veterans “not appropriate” for LCS, characterizing variation across sites in offering LCS, and whether
vulnerable groups (minorities, rural, homeless) are disproportionately deemed “not appropriate” for LCS. 2b-
Identify clinical and demographic factors associated with Veteran decisions to decline vs accept LCS. Aim 3:
We will interview up to 30 clinicians and 30 Veterans (15 who accepted, 15 who declined LCS) for whom
predicted LCS benefit is marginal based on our Aim 1 models. For clinicians, we will explore beliefs about,
expected outcomes of, and site-level influences on LCS decision-making, presenting vignettes to learn how
providing predicted LCS benefit (Aim 1 models) affects LCS decision-making. For patients, we will explore
experiences with LCS discussions, health priorities relative to LCS, and other influences on decision-making.
F...

## Key facts

- **NIH application ID:** 9842288
- **Project number:** 5I01HX002684-02
- **Recipient organization:** EDITH NOURSE  ROGERS MEMORIAL VETERANS HOSPITAL
- **Principal Investigator:** Renda Soylemez Wiener
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-01-01 → 2021-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9842288

## Citation

> US National Institutes of Health, RePORTER application 9842288, Achieving appropriate, safe, and patient-centered lung cancer screening (5I01HX002684-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9842288. Licensed CC0.

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