Cancer Center Support Grant

Fred Hutchinson Cancer Research Center, Seattle WA

Investigators

Linked publications, trials & patents

Abstract

As the population of persons living with HIV ages in the United States, lung cancer is now the leading cause of cancer death, with risk related to both increased tobacco use as well as independent risk associated with chronic HIV infection. Lung cancer screening with annual low-dose chest CT has been demonstrated to reduce lung cancer mortality by up to 20% in a subset of high risk smokers, though potential longitudinal benefits may be greatly reduced in those with comorbid illness. While lung cancer screening is both feasible and likely highly beneficial in many persons living with HIV, there are limited prospective data and no HIV-specific guidelines to support tailored lung cancer screening decision making in this population, who are at higher risk of lung cancer but also at risk for multimorbidity associated with aging. This study will bridge this significant knowledge gap through the iterative development and evaluation of tools to guide the shared decision making process for lung cancer screening in persons living with HIV. The study will consist of the following specific aims and approach: 1) Conduct a formative evaluation using qualitative methods to guide adaption and implementation of shared decision making for lung cancer screening tailored to persons living with HIV incorporating lung cancer risk as well as HIV severity, comorbidity and life expectancy; and 2) Pilot and evaluate tailored shared decision making using mixed-methods to assess the impact on patient knowledge and decisional conflict, as well as intervention acceptability, appropriateness and fidelity. Aim 1 includes focus groups of persons living with HIV and their primary providers to determine key barriers and facilitators to tailored shared decision making and the incorporation of measures of comorbidity and life expectancy into this process to develop a tailored shared decision making intervention for people living with HIV. Aim 2 is a single-arm feasibility trial to determine both the preliminary effectiveness and implementation of the shared decision making approach. The results of this study will be used to develop and refine tools for shared decision making for lung cancer screening in persons living with HIV, allowing for subsequent scale-up of implementation and assessment of effectiveness, reach and sustainability in a multicenter trial. This study directly addresses NIH high priority research topics of malignancy and comorbidity associated with HIV.