Individual decision making about lung cancer screening: A conjoint analysis of perspectives among a high‐risk national sample

Abstract

Abstract Objectives Lung cancer screening (LCS) is effective in reducing lung cancer mortality, but there is limited information available regarding preferences among high‐risk individuals concerning LCS. In this study, we use a conjoint valuation analysis (CVA) to better understand which LCS attributes most affect LCS preferences. Materials and Methods We implemented a web‐based nationally representative survey that included a full‐profile CVA exercise. Participants were over the age of 45, had at least a 20 pack‐year smoking history, and no history of lung cancer. The CVA instrument included five LCS attributes, and additional survey items collected demographic and psychosocial information. Results Participants (n = 210) had a mean age of 61 (SD 8.5) years, approximately half were female (51.9%), and were racially/ethnically diverse. Average relative importance of the LCS program attributes was (from high to low): out of pocket costs (27.3 ± 17.7); provider recommendation (24.8 ± 13.4); mortality reduction (17.2 ± 8.9); false‐positive rate (15.8 ± 10.4); and ease of access (14.8 ± 7.3). There was large variation among individuals, but few significant associations of propensity to screen with individual demographic characteristics. Average screening propensity across individuals (1‐9 scale) was 3.63 ± 1.6, and average rates of individual scenarios ranged from 2.60 ± 2.00 to 5.57 ± 2.13, indicating low inclination for screening. Conclusions We found that overall propensity for screening is low in a high‐risk population, and that out of pocket costs were of greater importance to potential screeners than mortality reduction or false‐positive rates. Thus, individuals considering or eligible for LCS need additional education and support regarding the LCS landscape in order to achieve informed decision making.

Keywords

• decision making
• lung cancer screening
• patient preferences