Preferences for Decision Control among a High-Risk Cohort Offered Lung Cancer Screening: A Brief Report of Secondary Analyses from the Lung Screen Uptake Trial (LSUT)

TY - JOUR

T1 - Preferences for Decision Control among a High-Risk Cohort Offered Lung Cancer Screening

T2 - A Brief Report of Secondary Analyses from the Lung Screen Uptake Trial (LSUT)

AU - Bonfield, Stefanie

AU - Ruparel, Mamta

AU - Waller, Jo

AU - Dickson, Jennifer L

AU - Janes, Samuel M

AU - Quaife, Samantha L

N1 - Funding Information: The authors thank all of those who were so dedicated in helping to deliver the Lung Screen Uptake Trial, which includes all staff at the participating primary care and secondary care sites. More specifically, they thank the Research Nurses and Clinical Trial Practitioners who carried out the Lung Health Check appointments (Claire Whipp, Juancho Salgado, Nilabhra Dutta, Amy Smith, Krishna Patel, Nivea Douglas, Gemma Hector, Derya Ovayolu, Agnieszka Zielonka, Celia Simeon, and Adelaide Austin), the radiologists and radiographers who carried out and interpreted the low-dose computed tomography scans (Penny Shaw, Stephen Burke, Magali Taylor, Asia Ahmed, May Jan Soo, Arjun Nair, Carolyn Horst, Nicholas Woznitza, and James Batty), and the primary care cancer leads who helped recruit primary care practices (Eleanor Hitchman and Lucia Grun). The authors are also very grateful to Anand Devraj for helping to develop the radiology protocol and training, as well as the Picture Archiving and Communication System managers at each hospital site (Junaid Chowdhury and Mohmed Patel). They really appreciate all of Kylie Gyertson’s and Christine Inwang’s work in helping us to plan, set up, and run the study at the hospital sites, as well as Badar Alavi’s efforts in administrating participants’ results letters. Thanks also to external members of our Trial Steering Committee (Thomas Newsom-Davies, Matthew Callister, Nicholas Counsell, and Judith Cass) and Independent Data Monitoring Committee (Michael Peake and Gianluca Baio). Finally, the authors would like to thank all of the participants who gave up their time to help with this research study. SLQ confirms that everyone who contributed significantly to this work has been acknowledged here. Relevant deidentified data are available upon reasonable request from SLQ. Funding Information: This work was conducted at the Research Department of Behavioural Science and Health, University College London. The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: SB, JW, and SLQ have no conflicts of interest to declare. SMJ is the chief investigator for an academic study (SUMMIT), which is sponsored and conducted by UCL and funded by GRAIL, Inc, through a research grant. JLD is, and MR has previously been, supported as investigators by this funding. SMJ has been paid by Astra Zeneca, BARD1 Bioscience, Jansen, and Achilles Therapeutics for being an Advisory Board Expert and travel to one US conference. SMJ receives grant funding from Owlstone for a separate research study. MR received travel funding for a conference from Takeda and an honorarium for planning and speaking at educational meetings from Astra Zeneca. All authors perceive that these disclosures pose no academic conflict for this study. All authors declare no other relationships or activities that could appear to have influenced the submitted work. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Financial support for this study was provided in part by a National Awareness and Early Diagnosis Initiative (NAEDI) project grant (C1418/A17976) from Cancer Research UK and a consortium of funders (Department of Health [England]; Economic and Social Research Council; Health and Social Care R&D Division, Public Health Agency, Northern Ireland; National Institute for Social Care and Health Research, Wales; and the Scottish government). This work was partly undertaken at UCLH/UCL who received a proportion of funding from the Department of Health’s NIHR Biomedical Research Centre’s funding scheme. SLQ is supported by a CRUK Population Research Fellowship (C50664/A24460) and a Barts Charity grant (MRC&U0036). JW is supported by a CRUK career development fellowship (C7492/A17219). SMJ was a Wellcome Trust Senior Fellow in Clinical Science (WT107963AIA). SMJ is supported by CRUK, the Rosetrees Trust, the Roy Castle Lung Cancer foundation, the Stoneygate Trust, the Garfield Weston Trust and UCLH Charitable Foundation. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing and publishing the report. Publisher Copyright: © The Author(s) 2023.

PY - 2023/3/27

Y1 - 2023/3/27

N2 - Background. Personal autonomy in lung cancer screening is advocated internationally, but health systems diverge in their approach, mandating either shared decision making (with a health care professional) or individual decision making. Studies of other cancer screening programs have found that individual preferences for the level of involvement in screening decisions vary across different sociodemographic groups and that aligning approaches with individual preferences has the potential to improve uptake. Method. For the first time, we examined preferences for decision control among a cohort of UK-based high-risk lung cancer screening candidates (N = 727). We used descriptive statistics to report the distribution of preferences and chi-square tests to examine associations between decision preferences and sociodemographic variables. Results. Most (69.7%) preferred to be involved in the decision with varying degrees of input from a health care professional. Few (10.2%) wanted to make the decision alone. Preferences were also associated with educational attainment. Conclusion. These findings suggest one-size-fits-all approaches may be inadequate in meeting diverse preferences, particularly those placing sole onus on the individual. Preferences for involvement in decision making about lung cancer screening are heterogeneous among high-risk individuals in the United Kingdom and vary by educational attainment. Further work is needed to understand how policy makers might implement hybrid approaches to accommodate individual preferences and optimize lung cancer screening program outcomes.

AB - Background. Personal autonomy in lung cancer screening is advocated internationally, but health systems diverge in their approach, mandating either shared decision making (with a health care professional) or individual decision making. Studies of other cancer screening programs have found that individual preferences for the level of involvement in screening decisions vary across different sociodemographic groups and that aligning approaches with individual preferences has the potential to improve uptake. Method. For the first time, we examined preferences for decision control among a cohort of UK-based high-risk lung cancer screening candidates (N = 727). We used descriptive statistics to report the distribution of preferences and chi-square tests to examine associations between decision preferences and sociodemographic variables. Results. Most (69.7%) preferred to be involved in the decision with varying degrees of input from a health care professional. Few (10.2%) wanted to make the decision alone. Preferences were also associated with educational attainment. Conclusion. These findings suggest one-size-fits-all approaches may be inadequate in meeting diverse preferences, particularly those placing sole onus on the individual. Preferences for involvement in decision making about lung cancer screening are heterogeneous among high-risk individuals in the United Kingdom and vary by educational attainment. Further work is needed to understand how policy makers might implement hybrid approaches to accommodate individual preferences and optimize lung cancer screening program outcomes.

UR - http://www.scopus.com/inward/record.url?scp=85160351180&partnerID=8YFLogxK

U2 - 10.1177/23814683231163190

DO - 10.1177/23814683231163190

M3 - Article

C2 - 37009636

SN - 2381-4683

VL - 8

SP - 23814683231163190

JO - MDM policy & practice

JF - MDM policy & practice

IS - 1

ER -