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Identifying Patients for Whom Lung Cancer Screening Is Preference-Sensitive: A Microsimulation Study.

Tanner J Caverly¹, Pianpian Cao², Rodney A Hayward¹

¹VA Center for Clinical Management Research and University of Michigan Medical School, Ann Arbor, Michigan (T.J.C., R.A.H.).

Annals of Internal Medicine

|May 30, 2018

Summary

Patient preferences significantly influence decisions about low-dose computed tomography (LDCT) lung cancer screening for individuals with lower risk or shorter life expectancy. For higher-risk individuals, screening benefits generally outweigh patient concerns.

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Area of Science:

Medical Screening
Health Services Research
Decision Analysis

Background:

Health systems are implementing low-dose computed tomography (LDCT) screening programs.
Effective and patient-centered implementation is a key challenge.

Purpose of the Study:

To examine factors influencing when LDCT screening is preference-sensitive.
To understand how patient preferences affect the net benefit of screening.

Main Methods:

A state-transition microsimulation model was utilized.
Data from randomized trials, decision analyses, and the SEER cancer registry were incorporated.
Simulated patients met U.S. Preventive Services Task Force eligibility criteria.

Main Results:

Screening appropriateness varied based on patient preferences for those with lower lung cancer risk (<0.3% annually) or shorter life expectancy (<10.5 years).
For approximately 50% of the study population at higher risk with longer life expectancy, screening benefits outweighed negative preferences.
False-positive rates and overdiagnosis had minimal influence on outcomes.

Conclusions:

Identifying preference-sensitive screening circumstances aids personalized clinician-patient discussions.
Tailoring screening recommendations to individual preferences and clinical benefit is crucial.