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Adaptation of a Tailored Lung Cancer Screening Decision Aid for People With HIV
Meagan C Brown1, Madison Snidarich1, Jehan Z Budak1
1Kaiser Permanente Washington Health Research Institute (M. C. Brown), the Department of Epidemiology (M. C. B.), the Department of Global Health (B. J W.), the Department of Health Services (B. J. W.), University of Washington School of Public Health, the Division of Public Health Sciences (M. C. B., M. S., and M. T.), Fred Hutchinson Cancer Center, the Division of Allergy and Infectious Diseases (J. Z. B.), the Division of Pulmonary, Critical Care and Sleep Medicine (N. M., K. C., and M. T.), the Division of Hematology and Oncology (N. G.), Department of Medicine, University of Washington, the Swedish Cancer Institute (P. E. R.), the Veterans Affairs Puget Sound Healthcare System (K. C.), Seattle, WA, and the Department of Learning Health Sciences (T. C.), University of Michigan, Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI.
Background:
People with HIV are both at elevated risk of lung cancer and at high risk of multimorbidity, which makes shared decision-making (SDM) for lung cancer screening (LCS) in people with HIV complex. Currently no known tools have been adapted for SDM in people with HIV.
Research Question:
Can an SDM decision aid be adapted to include HIV-specific measures with input from both people with HIV and their providers?
Study Design And Methods:
This study used qualitative methods including focus groups of people with HIV and interviews with HIV care providers to adapt and iterate an SDM tool for people with HIV. Eligible participants were those with HIV enrolled in an HIV primary care clinic who met age and smoking eligibility criteria for LCS and HIV care providers at the clinic. Both the focus groups and interviews included semistructured discussions of SDM and decision aid elements for people with HIV. We used a framework-guided thematic analysis, mapping themes onto the Health Equity Implementation framework.
Results:
Forty-three people with HIV participated in eight focus groups; 10 providers were interviewed. Key themes from patients included broad interest in adapting LCS SDM specifically for people with HIV, a preference for clear LCS recommendations, and the need for positive framing emphasizing survival. Providers were enthusiastic about personalized LCS risk assessments and point-of-care tools. Both patients and providers gave mixed views on the usefulness of HIV-specific risk measures in patient-facing tools. Themes were used to adapt a personalized and flexible SDM tool for LCS in people with HIV.
Interpretation:
People with HIV and providers were enthusiastic about specific tools for SDM that are personalized and tailored for people with HIV, that make recommendations, and that inform LCS decision-making. Divergent views on presenting patient-facing quantitative risk assessments suggests that these elements could be optional but available for review. This tool may have usefulness in complex decision-making for LCS in this population and currently is being evaluated in a pilot prospective trial.
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