Implementing Decision Coaching for Lung Cancer Screening in the Low-Dose Computed Tomography Setting

Abstract

PURPOSE: The uptake of shared decision making (SDM) for lung cancer screening (LCS) as required by the Centers for Medicare & Medicaid Services (CMS) is suboptimal. Alternative models for delivering SDM are needed, such as decision coaching in the low-dose computed tomography (LDCT) setting. METHODS AND MATERIALS: The Replicating Effective Programs framework guided our implementation of decision coaching, which included a patient-facilitated component before screening followed by in-person coaching that addressed the required elements for the SDM visit from CMS. We surveyed two LCS patient cohorts (pre-implementation and implementation of decision coaching) about their knowledge of LCS and perception of the SDM process. We conducted time-motion studies to assess the feasibility of implementing decision coaching and audio recorded clinical encounters from the implementation cohort to assess fidelity of the SDM conversation to the CMS requirements. RESULTS: Compared with the pre-implementation cohort (n = 51), the implementation cohort (n = 30) had greater knowledge of LCS ( P < .01) and reported a better SDM process ( P = .01). Coaching took 7.6 ± 4.1 minutes and did not increase visit time ( P = .72). Coaches addressed an average of 6.4 of 7 SDM elements required by CMS. CONCLUSION: Decision coaching in the LDCT setting provides an opportunity for patients to confirm their screening decision by ensuring that patients are truly informed about the potential harms and benefits of LCS. The decision coaching had excellent fidelity in addressing the required SDM elements from CMS and is feasible.

Understanding how and under what circumstances decision coaching works for people making healthcare decisions: a realist review

“…Men believed that it would provide them with an opportunity to speak to a health professional for an extended period of time, prior to consulting their GP [general practitioner].” [ 40 ] CMO4: Three roles (i.e., decision coach, patient, clinician) share a common goal of the patient being involved in decision making The three roles are committed to patients' involvement in decision making Sharing a common goal They work collaboratively as partners in decision making process [ 13 , 40 , 45 , 48 , 36 ] “Findings from our study… highlighting the relationship that needs to be built between GP [general practitioner], PN [practice nurse] and patient with respect to the decision-making process” [ 40 ] During decision coaching CMO5: Patients confide in the decision coach as a trusting relationship is built There is a trusting relationship between a decision coach and a patient Accepting coaching and willing to confide in the decision coach Patients progress in decision making [ 13 , 56 , 37 , 42 , 50 , 51 ] “A positive relationship based on trust was seen as central to the coach’s ability to support the patient. A trusting relationship enabled patients to be honest, ask questions, and express doubts or disagreements, which allowed the health coach to be more effective” [ 56 ] CMO6: Patients perceive their decisional needs are recognized by the decision coach A tailored approach to decision coaching, rather than a standardized protocol-based approach Perceiving their needs are recognized Patients progress in decision making [ 45 , 33 , 41 , 42 , 44 , 46 , 47 , 48 ] “The approach [supporting n...…”

Smoking cessation services and shared decision‐making practices among lung cancer screening facilities: A cross‐sectional study

“…A prior study demonstrated that shifting the responsibilities of SDM to a different provider role in an LDCT setting was feasible and could be done with high fidelity. 23 Notably, approximately twothirds of the facilities did not bill for an SDM visit for lung cancer screening. This finding helps to explain the low rate of SDM reported among individuals who underwent LDCT in studies using claims data from Medicare or commercial insurance.…”

“…More facilities reported that a nonphysician clinical staff delivered the SDM visit. A prior study demonstrated that shifting the responsibilities of SDM to a different provider role in an LDCT setting was feasible and could be done with high fidelity 23 . Notably, approximately two‐thirds of the facilities did not bill for an SDM visit for lung cancer screening.…”

Shared Decision-making in Urologic Practice: Results From the 2019 AUA Census

“…Prior literature has found that this is a commonly held assumption, however quantitative evidence has shown that shared decision making does not lengthen visit time. [7,9,13,14] In studies that have addressed this question, the time that is required by shared decision making made up by a decrease in time for other activities. [9,14] There is no standard approach to shared decision making and many paradigms involve use of decision aids and decision coaching to facilitate the process.…”

“…[7,9,13,14] In studies that have addressed this question, the time that is required by shared decision making made up by a decrease in time for other activities. [9,14] There is no standard approach to shared decision making and many paradigms involve use of decision aids and decision coaching to facilitate the process. [1,4,15,16] These adjuncts to be used either within the clinical encounter or before or after the encounter.…”