About this tool

This tool will help you and your patients discuss lung cancer screening and decide whether the potential benefit is worth the potential harms for each patient.
How will this tool help you?
  • Prepare to talk with patients by: 1) determining whether they're eligible and 2) designing a patient-centered recommendation based on the patient’s individual risk profile.
  • Talk to patients using the checklist provided. Use the evidence-based, personalized method of discussing benefits and harms, so patients can understand the trade-offs of screening.
  • Document your shared decision making in your medical record system with a simple copy and paste.
  • Share a printable report with your patients.
Why use this tool?
The degree of benefit from lung cancer screening depends on the person being screened. This tool will help you identify patients who would benefit from screening.
  • Evidence-Based Screening. Screening with low-dose computed tomography (LDCT) has been shown to reduce the number of deaths from lung cancer in groups at high risk.
  • Compares favorably with other cancer screening tests. For perspective, the reduction in deaths from lung cancer with CT screening is larger than the reduction in deaths from the target cancers of other common screening tests, such as mammograms for breast cancer.
  • Shared decision-making is recommended. The USPSTF recommends that health systems offer CT screening and that clinicians use shared decision making with patients, since there are both substantial benefits and substantial harms with CT screening.
  • Shared decision-making is required for payment. Medicare requires the use of a shared decision-making tool and that shared decision-making be documented. This tool makes shared decision-making easier and documentation automatic.
Evidence basis and development

Design and development

Center for Health Communications Research (CHCR)

6-year lung cancer risk estimates

This tool uses the risk prediction model developed by:
  1. Bach PB, Elkin EB, Pastorino U, et al. Benchmarking lung cancer mortality rates in current and former smokers. Chest. Dec 2004;126(6):1742-1749.
  2. Bach PB, Kattan MW, Thornquist MD, et al. Variations in lung cancer risk among smokers. J Natl Cancer Inst. Mar 19 2003;95(6):470-478.

Evidence basis for risk-based screening

  1. Kovalchik SA, Tammemagi M, Berg CD, et al. Targeting of low-dose CT screening according to the risk of lung-cancer death. N Engl J Med. Jul 18 2013;369(3):245-254.
  2. Katki HA, Kovalchik SA, Berg CD, Cheung LC, and Chaturvedi AK. “Development and Validation of Risk Models to Select Ever-Smokers for Ct Lung Cancer Screening.” JAMA 315, no. 21 (June 7, 2016): 2300–2311.
  3. Tammemägi, Martin C., Hormuzd A. Katki, William G. Hocking, Timothy R. Church, Neil Caporaso, Paul A. Kvale, Anil K. Chaturvedi, et al. “Selection Criteria for Lung-Cancer Screening.” New England Journal of Medicine 368, no. 8 (2013): 728–36.
  4. Modeling Study, Caverly, Cao, Hayward, Meza.

Contact

Please contact us with questions or comments regarding the lung cancer screening tool.

Angie Fagerlin, PhD
Salt Lake City VA Center for Informatics Decision Enhancement and Surveillance (IDEAS)
Department of Population Health Sciences
University of Utah School of Medicine

Tanner J. Caverly, MD, MPH
Ann Arbor VA Center for Clinical Management Research (CCMR)
Ann Arbor VA Medical Center
Departments of Internal Medicine and Learning Health Systems
University of Michigan Medical School

Disclaimer

The results and recommendations provided by this application are intended to inform clinicians but do not replace clinical judgment. Lung cancer screening decisions should be individualized and the determination on whether to screen should be based on a discussion between a patient and their clinician.

Expiration Date: January 31, 2019