Pilot Testing a Web-based Prototype of a Lung Cancer Screening Digital Health Tool

Lung cancer is the leading cause of cancer death in the US. In 2011, the landmark National Lung Screening Trial demonstrated that LCS using low-dose computed tomography (LDCT) can reduce lung cancer mortality by 20%, compared to chest X-rays, after annual screenings. Hence, the United States Preventive Services Task Force (USPSTF) recommends LCS for individuals age 50-80, who currently smoke or quit smoking within the past 15 years, and who have at least a 20 pack-year smoking history. The USPSTF gave LCS a Grade B recommendation, indicating that there is high certainty that the benefits of LCS outweigh the risks for this population. Despite the well-documented benefits of LCS and USPSTF's Grade B recommendation, LCS uptake remains very low at only 18%. In contrast, breast and colon cancer screening rates exceed 70%, even though their combined annual deaths are ¾ that of lung cancer. As LCS has both potential benefits and harms (e.g., false positives, small amounts of radiation exposure, potential invasive diagnostic testing), USPSTF also recommends that all patients undergo shared decision-making (SDM) prior to initial screening. Furthermore, the Centers for Medicare \& Medicaid Services (CMS) mandates an SDM conversation using a decision aid prior to initial screening. Yet, SDM is not routinely performed and patients are rarely informed about potential harms in routine practice. Hence, interventions aiming to improve LCS uptake and decision quality among high-risk populations are urgently needed to realize the mortality benefit of LCS.

To address these gaps, the investigators will develop a digital health tool, which is an interactive website that delivers high-quality, standardized SDM and psychoeducation about LCS to patients. This study's aims are to: 1) evaluate acceptability of the digital health tool prototype among people with a smoking history; 2) assess changes in cognitive outcomes before and after exposure to the digital health tool and across comparison groups; and 3) assess the digital health tool's impact on LCS intentions.

The digital health tool includes a home page and 7 modules: 1) a video decision aid about LCS; 2) video of the LDCT procedure; 3) lung cancer risk calculator and individualized lung cancer risk scores for patients; 4) patient testimonials; 5) frequently asked questions (e.g., costs associated with LDCT); 6) patient's decision; and 7) resources for smoking cessation.

For this pilot study, the investigators will be utilizing a quantitative approach using surveys. This study will use a randomized pre-post design to assess the impact of exposure to the digital health tool prototype. Participants (N=500) will be randomized to view either the digital health tool prototype or standard education materials about LCS in a 1:1 ratio. Participants will be contacted 3 months after the initial survey to complete a brief follow-up survey assessing LCS behavior.

Participants will be recruited through Qualtrics Research Panels. Potential participants will complete a screening form to confirm their eligibility. The inclusion criteria are: 1) age 50-80; and 2) currently smoke or quit smoking within the past 15 years. If they are eligible, potential participants will be directed to an informed consent form where they will be asked to indicate their agreement to participate in this study. Participants who agree to participate will then complete a pre-survey, use either the digital health tool prototype or standard education materials, and then complete a post-survey. 3 months after the initial survey, participants will be contacted again to complete a follow-up survey.

• Lung Cancer Screening Intention [Time frame: Immediately post-intervention (within 24 hours)]
• Stage of Decision Making [Time frame: Immediately post-intervention (within 24 hours)]
• Ottowa Acceptability Measure [Time frame: Immediately post-intervention (within 24 hours)]
• System Usability Scale (SUS) [Time frame: Immediately post-intervention (within 24 hours)]
• Knowledge of LCS [Time frame: Immediately post-intervention (within 24 hours)]
• Perceived risk [Time frame: Immediately post-intervention (within 24 hours)]
• Perceived benefits [Time frame: Immediately post-intervention (within 24 hours)]
• Perceived barriers [Time frame: Immediately post-intervention (within 24 hours)]
• Decisional Conflict (SURE) [Time frame: Immediately post-intervention (within 24 hours)]
• Preparation for Decision Making [Time frame: Immediately post-intervention (within 24 hours)]