Skip to main content

Advertisement

Log in

Patient Perspectives on the Risk-Based NLST Outcomes Tool for Lung Cancer Screening

  • Published:
Journal of Cancer Education Aims and scope Submit manuscript

Abstract

Researchers at the NCI have developed the Risk-Based NLST Outcomes Tool (RNOT), an online tool that calculates risk of lung cancer diagnosis and death with and without lung cancer screening, and false-positive risk estimates. This tool has the potential to facilitate shared decision making for screening. The objective of this study was to examine how current heavy and former smokers understand and respond to personalized risk estimates from the RNOT. Individuals who were eligible for lung cancer screening and were visiting Walter Reed National Military Medical Center were invited to participate in a semi-structured interview to assess their experiences with and perceptions of the RNOT. Results were analyzed using template analysis. Participants found their risk of lung cancer death to be lower than anticipated and were confused by changes in risk for lung cancer diagnosis with and without screening. Most participants indicated that the RNOT would be helpful in making screening decisions, despite reporting that there was no maximum risk for a false positive that would lead them to forgo lung cancer screening. Participants provided actionable needs and recommendations to optimize this tool. Risk-based screening tools may enhance shared decision making. The RNOT is being updated to incorporate these findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Draft recommendation statement: lung cancer: screening, U.S. Preventive Services Task Force, 2020. https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/lung-cancer-screening-20202020. Accessed 1 March 2021

  2. Katki HA, Kovalchik SA, Berg CD, Cheung LC, Chaturvedi AK (2016) Development and validation of risk models to select ever-smokers for CT lung cancer screening. JAMA. 315:2300–2311. https://doi.org/10.1001/jama.2016.6255

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. U.S. Preventive Services Task Force, Final reserach plan for lung cancer: screening, 2018. https://www.uspreventiveservicestaskforce.org/Page/Document/final-research-plan/lung-cancer-screening1.  Accessed 1 March 2021

  4. National Comprehensive Cancer Network, NCCN Clinical Practice Guidelines in Oncology: Lung Cancer Screening Version 2.2018, 2017. https://www.nccn.org/patients/guidelines/content/PDF/lung_screening-patient.pdf.  Accessed 1 March 2021

  5. Decision memo for screening for lung cancer with low dose computed tomography (LDCT) (CAG-00439N), Centers for Medicare & Medicaid Services, 2015. https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=274.  Accessed 1 March 2021

  6. Fukunaga MI, Halligan K, Kodela J, Toomey S, Furtado VF, Luckmann R, Han PKJ, Mazor KM, Singh S (2020) Tools to promote shared decision-making in lung cancer screening using low-dose CT scanning. Chest. S0012369220318468:2646–2657. https://doi.org/10.1016/j.chest.2020.05.610

    Article  Google Scholar 

  7. Risk-based NLST Outcomes Tool (RNOT), National Cancer Institute, Division of Cancer Epidemiology & Genetics, n.d. https://analysistools.nci.nih.gov/lungCancerScreening/#/.  Accessed 1 March 2021

  8. Agency for Healthcare Research and Quality, Is lung cancer screening right for me?, n.d. https://effectivehealthcare.ahrq.gov/decision-aids/lung-cancer-screening/patient.html.  Accessed 1 March 2021

  9. Should I Screen, Your Lung Cancer Risk, n.d. https://shouldiscreen.com/English/lung-cancer-risk-calculator. Accessed 1 March 2021

  10. Memorial Sloan Kettering Cancer Center, Lung cancer screening decision tool, n.d. http://nomograms.mskcc.org/Lung/Screening.aspx. Accessed 1 March 2021

  11. The Breast Cancer Risk Assessment Tool, National Cancer Institute, n.d. https://bcrisktool.cancer.gov/. Accessed 1 March 2021

  12. Colorectal Cancer Risk Assessment Tool, National Cancer Institute, n.d. https://ccrisktool.cancer.gov/. Accessed 1 March 2021

  13. Centers for Disease Control and Prevention, Trends in current cigarette smoking among high school students and adults, United States, 1965–2014, (2016). https://www.cdc.gov/tobacco/data_statistics/tables/trends/cig_smoking/. Accessed 1 March 2021

  14. Pinsky PF, Gierada DS, Black W, Munden R, Nath H, Aberle D, Kazerooni E (2015) Performance of Lung-RADS in the National Lung Screening Trial: a retrospective assessment. Ann Intern Med 162:485–491. https://doi.org/10.7326/M14-2086

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kinsinger LS, Anderson C, Kim J, Larson M, Chan SH, King HA, Rice KL, Slatore CG, Tanner NT, Pittman K, Monte RJ, McNeil RB, Grubber JM, Kelley MJ, Provenzale D, Datta SK, Sperber NS, Barnes LK, Abbott DH, Sims KJ, Whitley RL, Wu RR, Jackson GL (2017) Implementation of lung cancer screening in the Veterans Health Administration. JAMA Intern Med 177:399–406. https://doi.org/10.1001/jamainternmed.2016.9022

    Article  PubMed  Google Scholar 

  16. The National Lung Screening Trial Research Team (2011) Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365:395–409. https://doi.org/10.1056/NEJMoa1102873

    Article  PubMed Central  Google Scholar 

  17. Fowler SL, Klein WMP, Ball L, McGuire J, Colditz GA, Waters EA (2017) Using an internet-based breast cancer risk assessment tool to improve social-cognitive precursors of physical activity. Med Decis Mak 37:657–669. https://doi.org/10.1177/0272989X17699835

    Article  Google Scholar 

  18. American College of Radiology, Lung-RADSTM Version 1.0 Assessment Categories, 2014. https://www.acr.org/-/media/ACR/Files/RADS/Lung-RADS/LungRADS_AssessmentCategories.pdf?la=en.  Accessed 1 March 2021

  19. Brooks J, McCluskey S, Turley E, King N (2015) The utility of template analysis in qualitative psychology research. Qual Res Psychol 12:202–222. https://doi.org/10.1080/14780887.2014.955224

    Article  PubMed  Google Scholar 

  20. Hawley ST, Zikmund-Fisher B, Ubel P, Jancovic A, Lucas T, Fagerlin A (2008) The impact of the format of graphical presentation on health-related knowledge and treatment choices. Patient Educ Couns 73:448–455. https://doi.org/10.1016/j.pec.2008.07.023

    Article  PubMed  Google Scholar 

  21. Fuller R (2001) Risk communication and older people—understanding of probability and risk information by medical inpatients aged 75 years and older. Age Ageing 30:473–476. https://doi.org/10.1093/ageing/30.6.473

    Article  CAS  PubMed  Google Scholar 

  22. Krosnick JA, Malhotra N, Mo CH, Bruera EF, Chang L, Pasek J, Thomas RK (2017) Perceptions of health risks of cigarette smoking: a new measure reveals widespread misunderstanding. PLoS One 12:e0182063. https://doi.org/10.1371/journal.pone.0182063

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. National Cancer Institute, Smoking cessation at lung examination: the SCALE collaboration, n.d. https://cancercontrol.cancer.gov/brp/tcrb/scale-collaboration.html. Accessed 1 March 2021

  24. Joseph AM, Rothman AJ, Almirall D, Begnaud A, Chiles C, Cinciripini PM, Fu SS, Graham AL, Lindgren BR, Melzer AC, Ostroff JS, Seaman EL, Taylor KL, Toll BA, Zeliadt SB, Vock DM (2018) Lung cancer screening and smoking cessation clinical trials. SCALE (Smoking Cessation within the Context of Lung Cancer Screening) Collaboration. Am J Respir Crit Care Med 197:172–182. https://doi.org/10.1164/rccm.201705-0909CI

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ferrer R, Klein WM (2015) Risk perceptions and health behavior. Curr Opin Psychol 5:85–89. https://doi.org/10.1016/j.copsyc.2015.03.012

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This work was funded by internal National Cancer Institute funds.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Megan C. Roberts.

Ethics declarations

The views expressed in this article are those of the author and do not reflect the official policy of the Department of Army, Department of Defense, the NIH, or the U.S. Government.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

ESM 1

(DOCX 599 kb)

ESM 2

(DOCX 16 kb)

ESM 3

(DOCX 25 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Roberts, M.C., Seaman, E.L., Klein, W.M.P. et al. Patient Perspectives on the Risk-Based NLST Outcomes Tool for Lung Cancer Screening. J Canc Educ 37, 1438–1445 (2022). https://doi.org/10.1007/s13187-021-01977-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13187-021-01977-5

Keywords

Navigation