Brief Education and a Conjoint Valuation Survey May Reduce Decisional Conflict Regarding Lung Cancer Screening

Jamie L Studts; Richard J Thurer; Kory Brinker; Sarah E Lillie; Margaret M Byrne

doi:10.1177/2381468319891452

Brief Education and a Conjoint Valuation Survey May Reduce Decisional Conflict Regarding Lung Cancer Screening

MDM Policy Pract. 2020 Jan 10;5(1):2381468319891452. doi: 10.1177/2381468319891452. eCollection 2020 Jan-Jun.

Authors

Jamie L Studts¹, Richard J Thurer², Kory Brinker³, Sarah E Lillie⁴, Margaret M Byrne⁵

Affiliations

¹ Department of Behavioral Science, University of Kentucky Markey Cancer Center, Lexington, Kentucky.
² Department of Surgery, Division of Cardiothoracic Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida.
³ Behavioral and Community-Based Research Shared Resource Facility, University of Kentucky Markey Cancer Center, Lexington, Kentucky.
⁴ Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota.
⁵ Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida.

Abstract

Background. Recent data and policy decisions have led to the availability of lung cancer screening (LCS) for individuals who are at increased risk of developing lung cancer. In establishing implementation policies, the US Preventive Services Task Force recommended and the Centers for Medicare and Medicaid Services required that individuals who meet eligibility criteria for LCS receive a patient counseling and shared decision-making consultation prior to LCS. Methods. This study evaluated the potential of a values clarification/preference elicitation exercise and brief educational intervention to reduce decisional conflict regarding LCS. Participants (N = 210) completing a larger online survey responded to a measure of decisional conflict prior to and following administration of a conjoint survey and brief educational narrative about LCS. The conjoint survey included 22 choice sets (two of which were holdout cards), incorporating 5 attributes with 17 levels. Results. Results pertaining to changes in decisional conflict showed that participants reported statistically significantly and clinically meaningful reductions in decisional conflict following administration of the brief educational narrative and conjoint survey across the total score (Δ = 29.30; d = 1.09) and all four decisional conflict subscales: Uncertainty (Δ = 27.75; d = 0.73), Informed (Δ = 35.32; d = 1.11), Values Clarity (Δ = 31.82; d = 0.85), and Support (Δ = 18.78; d = 0.66). Discussion. While the study design precludes differentiating the effects of the brief educational narrative and the conjoint survey, data suggest that these tools offer a reasonable approach to clarifying personal beliefs and perspectives regarding LCS participation. Given the complicated nature of LCS decisions and recent policies advocating informed and shared decision-making approaches, conjoint surveys should be evaluated as one of the tools that could help individuals make choices about LCS participation.

Keywords: conjoint analysis; decision making; lung cancer screening; patient preferences.

Abstract

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