Tensions in Implementation: A Mixed-Methods Evaluation of a Lung Cancer Screening Shared Decision-Making Aid for...

Area of Science:

• Implementation Science
• Public Health
• Oncology

Background:

• People with HIV (PWH) face elevated lung cancer risk, yet lung cancer screening (LCS) remains understudied in this demographic.
• A previously developed shared decision-making (SDM) aid, adapted for PWH, showed efficacy in enhancing LCS knowledge.

Purpose of the Study:

• To conduct a mixed-methods evaluation of the implementation of an HIV-adapted SDM aid for LCS among PWH.
• To identify implementation tensions and inform strategies for optimizing SDM in this population.

Main Methods:

• A mixed-methods approach involving LCS-eligible PWH.
• Forty participants reviewed tailored decision aids during SDM visits, completing pre-/post-surveys.
• Fifteen participants engaged in semi-structured interviews analyzed thematically using the Health Equity Implementation Framework.

Main Results:

• The SDM aid was generally approved for explaining LCS risks/benefits.
• Key implementation tensions included balancing clinician trust with patient autonomy, individualizing care, addressing systemic barriers, managing emotional responses to screening information, differing clinician preferences, and varied smoking cessation motivations.

Conclusions:

• The adapted SDM aid was well-received by PWH.
• Iterative adaptation of the decision aid and communication strategies is crucial for optimizing SDM and LCS uptake in people with HIV.