Maximizing Benefits and Minimizing Harms of Lung Cancer Screening

Development of a Conceptual Map of Negative Consequences for Patients of Overuse of Medical Tests and Treatments

“…Nearly all case descriptions (49 [91%]) described the overuse cascade, with a mean of 4.2 downstream services identified per case and 227 downstream services mentioned in total. Figure 2 illustrates 2 examples of the overuse cascade from case descriptions …”

“…Figure 2 illustrates 2 examples of the overuse cascade from case descriptions. 31,32 The cases described a mean of 3.2 negative consequences per case. All cases identified at least 1 short-term negative consequence.…”

“…Descriptions of treatment burden were especially unclear: many cases, for example, mentioned that patients had experienced excess hospitalization during the overuse cascade, but few explicitly identified this as a negative consequence or Case examples in which an abnormal result of an unnecessary test leads to a series of downstream services. 31,32 These services may represent appropriate responses to abnormal findings or may include additional unnecessary services or medical errors, leading to negative consequences for patients. A, Unnecessary screening low-dose computed tomography (LDCT) scan (overused service) revealed scattered nodules.…”

Impact of a Hybrid Lung Cancer Screening Model on Patient Outcomes and Provider Behavior

“…We found that the addition of a NN almost completely eliminated screening of ineligible patients and improved compliance with SDM and TCC requirements to >95%. The screening of ineligible patients remains a problem as LCS uptake increases 19,20 and is potentially harmful 21 . We also observed an increase in calculated lung cancer risk over time that persists even when ineligible patients were eliminated from analysis (Fig 5B).…”

The impact of patients’ preferences on the decision of low-dose computed tomography lung cancer screening

“…However, there is still some controversy regarding high false positive rate of LDCT, unnecessary further diagnostic testing and invasive procedure, patient anxiety and overdiagnosis (5). Shared decision making (SDM) for lung cancer screening is recommended for promoting patient-centered clinician communication due to the uncertainty regarding the risks and benefits of screening (6,7).…”