Information sheet after lung cancer screening results helpful, but discussion still needed
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Key takeaways:
- When surveyed, only 55% of individuals screened for lung cancer knew what a lung nodule was.
- A commonly asked questions sheet given after screening results was positively received and deemed helpful.
A commonly asked questions sheet addressing needs related to comprehension of lung cancer screening results was positively received by patients and clinicians, according to study results published in CHEST.
However, patients said this tool should not take the place of discussions with clinicians, according to researchers.
“In this study, we identified patient information needs after lung cancer screening, elicited reactions and recommendations from patients and clinicians on letters reporting results of different Lung Imaging Reporting and Data System (Lung-RADS) findings, and developed a commonly asked questions sheet to improve communication and understanding of these results,” Kristina Crothers, MD, professor in the division of pulmonary, critical care and sleep medicine at the University of Washington, and colleagues wrote.
In a multicenter mixed-methods study, Crothers and colleagues first analyzed survey results from 190 individuals (average age, 65 years; 34% women; 83% white) who underwent lung cancer screening to evaluate their understanding of their results and find knowledge gaps. With these findings, they created a commonly asked questions sheet for individuals to read after receiving their screening results letter.
For further understanding of how individuals respond to resources, including result letters and the new commonly asked questions sheet, researchers included 31 individuals (68% men) in 16 interviews and six focus group discussions.
Six clinicians with lung cancer screening experience were also interviewed in this analysis to hear their thoughts on the same items.
Survey findings
When looking at survey results, researchers observed a 43% response rate.
Most individuals (88%) reported having an understanding of their screening results, but this contrasted with the nearly half (45%) of respondents who said they did not know what a lung nodule is. When questioned about the importance of additional information on nodules, the prevalence of nodules and the risks for lung cancer, researchers found that 59% to 63% marked these items as “very important.”
Additionally, 75% of respondents deemed it “very important” that screening results provide additional information on lung diseases that can appear on low-dose CT scans. A similar response (69%) was found for heart diseases.
A desire for more information on results overall was observed in 51% of the responses, whereas one-third (33%) answered that they did not want additional information and 16% were unsure as to whether they wanted more.
Interview/focus group findings
In discussing the topic of result letters with patients, researchers found varying reactions to the Lungs-RADS 1 letter, with some thinking it was enough and others desiring to see their doctor. On the other hand, getting a Lung-RADS 3 or Lung-RADS S letter was identified by every patient as a scenario where they wanted to speak with their clinician and was expressed as “concerning and alarming” in the interviews.
Notably, both clinicians and most patients were apprehensive about sending/receiving personalized letters about screening results and agreed that letters conveying results should be “simple and concise.”
When asked about the commonly asked questions sheet, researchers found that it was positively received by the majority of patients and clinicians. Even if their screening results were not bad, a few patients expressed that they wanted to be informed and said the information sheet could fulfill this desire.
With many patients expressing a lack of knowledge on lung nodules, similar to survey results, they said details about nodules on the sheet were helpful. Details on incidental lung and heart diseases on CT scans were also deemed useful, according to researchers’ account of patient interviews.
One notable disagreement found when comparing clinician interviews to patient interviews was the proposal to emphasize quitting smoking on the sheet. Clinicians vocalized that this was a priority, whereas some patients said that they are aware of the importance of quitting so more information would be unnecessary.
Despite positive feedback on the created information sheet, patients said it should not take the place of talking to a clinician, and instead said it is a “supplement” that helps patients determine what they want to ask their doctor and/or to clarify what their doctor told them.
Researchers also asked for recommendations to improve the sheet, to which patients suggested adding links to relevant websites, such as the American Lung Association and CDC, as well as relevant phone numbers.
Other recommendations included clearer and more compassionate language, fewer words and more graphics.
“A simple-to-implement commonly asked questions information sheet seems promising in improving knowledge regarding lung cancer screening results and informing patients with questions they can clarify with their clinicians,” Crothers and colleagues wrote. “Further studies assessing implementation of the commonly asked questions and impact on patient outcomes after lung cancer screening are needed.”
This study by Crothers and colleagues adds to growing literature on the importance of lung cancer screening, specifically in terms of how patients comprehend their results; however, the tool developed needs to be tested further and needs to consider individuals who have low health literacy or are not proficient in English, according to an accompanying editorial by Katharine A. Rendle, PhD, MSW, MPH, assistant professor of family medicine and community health and of epidemiology at University of Pennsylvania’s Perelman School of Medicine, and Anil Vachani, MD, director of clinical researcher in the section of interventional pulmonary and thoracic oncology at Penn Medicine.
Rendle and Vachani also explain the possible benefit of pairing this tool with other tools to increase patients’ understanding of their results.
“This work is an essential start, but more work is needed to assess impact of this and other communication strategies on a patient’s understanding, distress, and adherence to follow-up care,” Rendle and Vachani wrote. “Additionally, sending information does not mean that it will be read and used or result in the collaborative communication and high-quality care, particularly for those patients who may face additional barriers such as lower health literacy. Coupling information tools such as the one developed by Crothers et al with timely telehealth visits or tailored information videos could be one option to facilitate patient comprehension and provide an opportunity to ask questions and allow clinicians to ensure that all results and recommendations are fully understood by the patient.”