Informed choice for lung cancer screening: A randomised trial of three decision support tools

Shared decision-making in the Australian National Lung Cancer Screening Program (NLCSP) involves consultation between healthcare provider and individual to ensure participants make an informed choice about screening. Three decision support tools were co-designed: a 16-page A5 booklet (booklet), 2-page A4 leaflet (leaflet) and a 3-minute animated video (video). This randomised trial evaluated the tools' ability to support informed choice, attitudes/intentions towards lung cancer screening, acceptability, comprehension, ease of understanding and balance of information of the tool. An online survey was conducted with people eligible for the Australian NLCSP. Participants were randomised to view one of the tools and completed a questionnaire. The primary outcome was informed choice (defined as adequate knowledge and congruency between attitudes and screening intentions). 715 participants completed the survey: booklet (n = 221), leaflet (n = 252) and video (n = 242). There was no statistically significant difference in informed choice between tools; informed choice was made by 148 (67 %) people who viewed the booklet, 167 (66.3 %) for the leaflet and 153 (63.2 %) for the video. Across all the tools, over 90 % found the information clear and easy to understand, around 85 % found the tool they viewed as helpful in deciding about screening, and around 80 % would recommend the viewed tool to others. Almost 80 % in each group intended to participate in lung cancer screening. Attitudes towards screening were significantly less positive for those viewing the leaflet than the booklet or video (p = 0.006). Each decision support tool was acceptable, supported informed choice, and could be adapted for use in the Australian NLCSP.