Impact of a Lung Cancer Screening Information Film on Informed Decision-making: A Randomized Trial

Abstract

Rationale: Lung cancer screening has the potential to save lives, but it also carries a risk of potential harms. Explaining the benefits and harms of screening in a way that is balanced and comprehensible to individuals with various levels of education is essential. Although a shared decision-making approach is mandated by the Centers for Medicare & Medicaid Services, there have been no randomized studies to evaluate the impact of different forms of lung screening information. Objectives: To evaluate the impact of a novel information film on informed decision-making in individuals considering participating in lung cancer screening. Methods: A subset of participants from LSUT (Lung Screen Uptake Trial) were randomly allocated either to view the information film and receive a written information booklet or to receive the booklet alone. The primary outcome was the objective knowledge score after intervention. Secondary outcomes included subjective knowledge, decisional conflict, final screening participation, and acceptability of the materials. Univariate and multivariate analyses were performed to determine differences in pre- and postintervention knowledge scores in both groups and between groups for the primary and secondary outcomes. Results: In the final analysis of 229 participants, both groups showed significantly improved subjective and objective knowledge scores after intervention. This improvement was greatest in the film + booklet group, where mean objective knowledge improved by 2.16 points (standard deviation [SD] 1.8) compared with 1.84 points (SD 1.9) in the booklet-alone group (β coefficient 0.62; confidence interval, 0.17-1.08; P = 0.007 in the multivariable analysis). Mean subjective knowledge increased by 0.92 points (SD 1.0) in the film + booklet group and 0.55 points (SD 1.1) in the booklet-alone group (β coefficient 0.32; CI, 0.05-0.58; P = 0.02 in the multivariable analysis). Decisional certainty was higher in the film + booklet (mean 8.5/9 points [SD 1.3], group than in the booklet-alone group (mean 8.2/9 points [SD 1.5]). Both information materials were well accepted, and there were no differences in final screening participation rates between groups. Conclusions: The information film improved knowledge and reduced decisional conflict without affecting lung-screening uptake. Clinical trial registered with clinicaltrials.gov (NCT02558101).

Keywords: educational video; information film; informed decision-making; lung cancer screening; shared decision-making.

Figure 1.

Consort diagram of the study participants. LSUT = Lung Screen Uptake Trial.

Figure 2.

Knowledge scores by intervention group. (A) Change in objective knowledge scores, before and after intervention (both groups). (B) Change in subjective knowledge scores, before and after intervention (both groups).

Figure 3.

Acceptability of the film and information booklet. (A) Percentage of participants stating that the information materials were useful, not difficult to understand, informative, not too complicated, and provided enough information (including responses to film [film group only] and information booklet [both groups]). (B) Amount of the information materials read/watched and understood in both groups. (C) Film group only: how much participants believed the film helped them decide whether or not to be screened. (D) Film group only: how balanced they perceived the film to be.