• Stephen D Clark, Daniel S Reuland, Alison T Brenner, and Daniel E Jonas.
• Division of General Internal Medicine, Department of Medicine, Virginia Commonwealth University, 1101 East Marshall St., Sanger Hall 1-010, Box, Richmond, VA, 980102, USA. Stephen.clark1@vcuhealth.org.
• J Gen Intern Med. 2022 Nov 1; 37 (14): 367636833676-3683.

BackgroundThe Centers for Medicare & Medicaid Services requires decision aid use for lung cancer screening (LCS) shared decision-making. However, it does not require information about incidental findings, a potential harm of screening.ObjectiveTo assess the effect of incidental findings information in an LCS decision aid on screening intent as well as knowledge and valuing of screening benefits and harms.DesignRandomized controlled trial conducted online between July 16, 2020, and August 22, 2020.ParticipantsAdults 55-80 years, eligible for LCS.InterventionLCS video decision aid including information on incidental findings or a control video decision aid.Main MeasuresIntent to undergo LCS; knowledge regarding the benefit and harms of LCS using six knowledge questions; and valuing of six benefits and harms using rating (1-5 scale, 5 most important) and ranking (ranked 1-6) exercises.Key ResultsOf 427 eligible individuals approached, 348 (83.1%) completed the study (173 intervention, 175 control). Mean age was 64.5 years, 48.6% were male, 73.0% white, 76.3% with less than a college degree, and 64.1% with income < $50,000. There was no difference between the intervention and controls in percentage intending to pursue screening (70/173, 40.5% vs 73/175, 41.7%, diff 1.2%, 95% CI - 9.1 to 11.5%, p = 0.81). Intervention participants had a higher percentage of correct answers for the incidental findings knowledge than controls (164/173, 94.8% vs 129/175, 73.7%, 95% CI - 28.4 to - 13.8%, p < 0.01). Incidental findings had the fifth highest mean importance rating (4.0 ± 1.1) and the third highest mean ranking (3.6 ± 1.5). There was no difference in mean rating or ranking of incidental findings between intervention and control groups (rating 4.0 vs 3.9, diff 0.1, 95% CI - 0.2, 0.3, p = 0.51; ranking 3.6 vs 3.6, diff 0.02, 95% CI - 0.3, 0.3, p = 0.89).ConclusionsIncidental findings information in a LCS decision aid did not affect LCS intent, but it resulted in more informed individuals regarding these findings. In formulating screening preferences, incidental findings were less important than other benefits and harms.Trial RegistrationClinicalTrials.gov identifier: NCT04432753.© 2022. The Author(s) under exclusive licence to Society of General Internal Medicine.

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