How Patients View Lung Cancer Screening. The Role of Uncertainty in Medical Decision Making

Abstract

Rationale: Radiographic lung cancer screening guidelines and coverage requirements warrant a shared decision-making process. Guidance is needed regarding how to conduct shared decision making effectively. A useful organizing theme should include consideration of a patient's response to and tolerance of uncertainty associated with lung cancer screening.Objectives: The objectives of this study are to: (1) describe how patients respond to specific categories of uncertainty in the context of lung cancer screening, and (2) inform strategies for addressing concerns about uncertainty as part of the shared decision making.Methods: We performed two series of structured interviews on participants in a convenience sample of current or former cigarette smokers recruited from primary care and pulmonary practices in Philadelphia. An interview guide included prompts related to benefits, harms, and responses to general and specific types of uncertainty (stochastic, statistical, and evidentiary) associated with lung cancer screening. Interviews were audio-recorded, transcribed, and independently coded by two investigators. An inductive analysis was conducted, and major themes were identified.Measurements and Main Results: Twenty-two adults participated in the study. Sixty-eight percent were men, 72% were black or African American, and 50% met U.S. Preventive Services Task Force criteria for lung cancer screening. The primary themes to emerge from our study were: (1) the desire to decrease uncertainty may motivate lung cancer screening decisions; (2) uncertainty is an attribute of health states that impacts how patients weigh benefits and harms of lung cancer screening; (3) patient understanding and tolerance of uncertainty varies across stochastic, statistical, and evidentiary uncertainty; and (4) provider-patient communication may mitigate intolerance of uncertainty in the context of lung cancer screening. Conclusions:A systematic approach to understanding and addressing patients' concerns about uncertainty in the context of lung cancer screening can guide a patient-centered approach to shared decision making. The results of this study can inform provider-patient communication strategies regarding the decision to perform radiographic lung cancer screening.

Defining the information needs of lung cancer screening participants: a qualitative study

“…However, many participants were reassured by the prospect of interval scanning and felt that psychological distress could be reduced by education around the low subsequent risk of developing cancer in the context of indeterminate pulmonary nodules. Studies have found individual differences in tolerance of uncertainty, that can affect how people weigh up benefits and risks, and that communication which effectively prepares patients for this likelihood, may mitigate poor tolerance of uncertainty36 and distress associated with pulmonary nodules 37 38…”

The impact of perceived risk, screening eligibility and worry on preference for lung cancer screening: a cross-sectional survey

“…A significant lung cancer screening implementation issue is to engage those at high risk, in whom the harm/benefit ratio is favourable, while at the same time minimising screening in those at low risk of lung cancer who have an unfavourable harm/benefit ratio. Previous qualitative studies have similarly described how emotional concerns about lung cancer or uncertainty can influence screening intentions of potential participants [12,13]. Understanding the factors that contribute to a preference for participation in lung cancer screening will better inform screening programmes in order to meet this challenge.…”

Patient and Clinician Perspectives on Shared Decision-making in Early Adopting Lung Cancer Screening Programs: a Qualitative Study

“…20,34,35 Patients, including those with low literacy, value receiving clear LCS information from a decision aid, particularly when reviewed with a clinician. 12,20,34,36,37 In particular, preparing patients for the possibility of a screen-detected nodule and the work-up that might ensue through clear, patient-centered communication may help mitigate future distress patients may experience if a nodule is found. 38 In real-world settings, higher quality communication about incidental pulmonary nodules is associated with lower distress and improved adherence to evaluation.…”