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Stephen Duffy
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P2.11 - Screening and Early Detection (Not CME Accredited Session) (ID 960)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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P2.11-29 - Impact of an Information-Film to Promote Informed Decision-Making in Individuals Taking Part in a Lung Cancer Screening Demonstration Pilot (ID 12757)
16:45 - 18:00 | Author(s): Stephen Duffy
- Abstract
Background
Lung cancer screening by Low Dose CT (LDCT) is underway in the United States, where a shared decision-making process is mandated for insurer funding. The potential harms of screening are complex and difficult to communicate. Participants do not always read written materials and audio-visual aids have been shown to improve informed decision-making in other areas of medicine. There are limited studies on the use of decision aids in lung cancer screening.
a9ded1e5ce5d75814730bb4caaf49419 Method
A five-minute information-film was made to explain the benefits and risks of lung cancer screening. Qualitative research informed the content and format to make it accessible for individuals of varying demographic and educational backgrounds. A sub-sample of participants (n=229) from a lung cancer screening pilot were randomised to watch the film and read a written information booklet (Group A) or read the booklet alone (Group B). Objective and subjective knowledge of the risks and benefits of screening were assessed before and after the intervention, and again after discussion with a heath care professional, when decisional conflict and satisfaction were also assessed.
4c3880bb027f159e801041b1021e88e8 Result
120 and 109 participants were randomised to groups A and B respectively. There was a statistically significant improvement in subjective and objective knowledge scores post-administration of the intervention in both groups (p<0.001). In a multivariate analysis adjusted for educational level and baseline knowledge score, post interventional scores were independently associated with film group (p=0.036). There were no group differences in decisional conflict or satisfaction, or in subsequent attendance for LDCT. Participants’ views on the acceptability of the film are presented in table 1.
Table 1: Feedback and acceptability of information film
8eea62084ca7e541d918e823422bd82e Conclusion
The information-film was well-accepted and increased knowledge scores more than a written booklet alone, without raising decisional conflict or reducing attendance for LDCT.
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P3.11 - Screening and Early Detection (Not CME Accredited Session) (ID 977)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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P3.11-13 - Liverpool Identifies the Hard to Reach Population at Risk of Developing Lung Cancer. (ID 13173)
12:00 - 13:30 | Author(s): Stephen Duffy
- Abstract
Background
The Liverpool Healthy Lung Programme (LHLP) is an initiative aimed at improving respiratory health and diagnosing respiratory disease at a more treatable stage, taken by the Liverpool Clinical Commissioning Group (CCG) working with communities across Liverpool. Liverpool has one of the highest respiratory morbidity rates in England, with double the national lung cancer incidence, particularly in lower socioeconomic groups. The Liverpool Healthy Lung Programme was initiated in response to both the clinical problem and the health inequality.
a9ded1e5ce5d75814730bb4caaf49419 Method
General practice records targeted ever-smokers and subjects with chronic obstructive pulmonary disease (COPD), 58-70y and were invited for 45-minute lung health check. Positive lifestyle messages were promoted; 5-year personal lung cancer risk calculated (www.MyLungRisk.org using LLPv2 risk model). Those who trigger the 5% threshold were offered a LDCT-scan. Spirometry was used to assess lung function (FEV1/FVC); those with abnormal results referred for potentially definitive diagnosis of COPD. Smoking advice and referrals to smoking cessation clinics were provided. Patients CT detected nodules were managed, based on BTS guidelines; referred to MDT for work-up and significant other findings (SoF) were analysed in detail.
4c3880bb027f159e801041b1021e88e8 Result
3,591 Healthy Lung Programme consultations (consented). 11,526 people were invited, 4,566 (40%) attended. 1,853 (52%) were male, 2,897 (81%) in the most deprived IMD quintile. 832 (23%) subjects had an existing diagnosis of COPD and 527 (15%) had a previous diagnosis of cancer. 1,173 (33%) subjects had a family history of cancer.
1,548 (99.3% meeting LLPv2 5% risk criterion) were offered CT scan. 119 (9%) patients required further investigations (follow-up CT scan at 3 or 12 months, or immediate MDT referral), 25 (1.9% undergoing CT scan) were diagnosed with lung cancer (11 have suspected lung cancer, undergoing further investigations). Analysis of a sub-set of the SoF findings were followed up and indicated benefit to participants.
8eea62084ca7e541d918e823422bd82e Conclusion
The results suggest that it is feasible to achieve similar clinical outcome benefits to those observed in the US trial of LDCT screening for lung cancer, with lesser harms in terms of unnecessary diagnostic activity. However, this needs confirmation with extended follow-up, larger numbers of lung cancers diagnosed, and the addition of mortality data. Additional randomised trial results would also add to the precision of estimation of benefits and harms, in particular mortality results from the large European trial, NELSON. In the meantime, the results of LHLP suggest that it is succeeding in early detection of both COPD and lung cancer.
6f8b794f3246b0c1e1780bb4d4d5dc53
