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

Wiener, Renda Soylemez; Koppelman, Elisa; Bolton, Rendelle E.; Lasser, Karen E.; Borrelli, Belinda; Au, David H.; Slatore, Christopher G.; Clark, Jack A.; Kathuria, Hasmeena

doi:10.1007/s11606-018-4350-9

Cited by 86 publications

(92 citation statements)

References 39 publications

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“…An often‐reported barrier is time constraints . While there is a clear need for system change including compensation to allow time for SDM, recent empirical evidence suggests that SDM may demand little additional time.…”

Section: Barriers To Sdm Implementationmentioning

confidence: 99%

“…While the time barrier makes physicians reluctant to engage in SDM, additional barriers include poor skills and knowledge. Clinicians admit that they lack risk communication skills and perceive that patients are reluctant to engage in SDM . Physicians often tend to persuade their patients to choose the clinician's preferred course of action and fail to implement SDM.…”

Section: Barriers To Sdm Implementationmentioning

confidence: 99%

“…Guidelines recommend (and Medicare requires) SDM before referring individuals to Computerized tomography (CT) screening for lung cancer. In a qualitative study, 85 clinicians and patients were interviewed to explore the degree of SDM implementation in real‐world practice . Some patients felt they received little information about the test or its trade‐offs and did not realize the purpose of the CT. Clinicians and patients alike did not perceive that significant deliberation had occurred, including expression and discussion of treatment preferences …”

Section: Barriers To Sdm Implementationmentioning

confidence: 99%

“…An often-reported barrier is time constraints. 11,12 While there is a clear need for system change including compensation to allow time for SDM, recent empirical evidence suggests that SDM may demand little additional time. In a simulation, subjects reported significantly higher trust and satisfaction (as well as lower willingness to sue for an adverse outcome) when exposed to a clinical vignette with SDM in comparison with a controlled simulation without SDM.…”

Section: Barriers To Sdm Implementationmentioning

confidence: 99%

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Meaningful shared decision‐making: complex process demanding cognitive and emotional skills

Stalnikowicz

Brezis

2020

Evaluation Clinical Practice

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Background Shared decision‐making (SDM) takes place when clinicians help patient identify best course of action in the context of their preferences. Methods The aim of this paper is a narrative review of the literature with special focus on the humanistic dimensions of SDM. Results We show that SDM is largely underused in practice, because of many barriers such as time constraints and poor skills. Conclusions We suggest that listening and empathy are key challenges in communicating uncertainty, which require emotional intelligence and trust building skills. To promote implementation, we propose the development of tools, simulation‐based training and the design of improved measures for SDM quality. While essential for patients, we believe that SDM may restore meaning in healthcare.

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Section: Barriers To Sdm Implementationmentioning

confidence: 99%

Section: Barriers To Sdm Implementationmentioning

confidence: 99%

Section: Barriers To Sdm Implementationmentioning

confidence: 99%

Section: Barriers To Sdm Implementationmentioning

confidence: 99%

See 2 more Smart Citations

Meaningful shared decision‐making: complex process demanding cognitive and emotional skills

Stalnikowicz

Brezis

2020

Evaluation Clinical Practice

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“…1 The study methods were elegantly designed to provide parallel perspectives from the clinician and patient regarding key aspects of the SDM construct: information sharing, deliberation, and use of decision aids. The parallel process of data collection and analysis provides an opportunity to compare and contrast perspectives.…”

mentioning

confidence: 99%

The Conundrum and Challenge of Lung Cancer Screening Shared Decision-making Implementation

Schapira

2018

J GEN INTERN MED

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Assessment of Lung Cancer Screening Program Websites

et al. 2020

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recommends that individuals at high risk for lung cancer consider benefits and harms before pursuing lung cancer screening. Medical centers develop websites for their lung cancer screening programs, but to date little is known about the websites' portrayal of benefits and harms or what next steps they recommend for individuals considering screening.OBJECTIVE To assess the presentation of potential benefits and harms and recommended next steps on lung cancer screening program websites. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional content analysis of 162 lung cancer screening program websites of academic medical centers (n = 81) and state-matched community medical centers (n = 81) that were randomly selected from American College of Radiology lung cancer screening-designated centers was conducted. The study was performed from December 1, 2018, to January 31, 2019. MAIN OUTCOMES AND MEASURESWebsite presentation of screening-associated benefits and harms was the primary outcome. Benefit was defined as any description related to the potential reduction in lung cancer mortality. Harms were based on the US Preventive Services Task Force recommendations and included false positives, false negatives, overdiagnosis, radiation exposure, and incidental findings. The secondary outcome was next steps that are recommended by websites.RESULTS Overall, the 162 lung cancer screening program websites described the potential benefits more frequently than they described any potential harms (159 [98%] vs 78 [48%], P < .01). False-positive findings were the most frequently reported (72 [44%]) potential harm. Community centers were less likely than academic centers to report any potential harm (32 [40%] vs 46 [57%], P = .03), potential harm from radiation (20 [25%] vs 35 [43%], P = .01), and overdiagnosis (0% vs 11 [14%], P < .01). One hundred nineteen websites (73%) did not explicitly recommend that individuals personally consider the potential benefits and harms of screening; community centers were less likely than academic centers to give this recommendation (15 [19%] vs 28 [35%], P = .02). Most institutions (157 [97%]) listed follow-up steps for screening, but few institutions (35 [22%]) recommended that individuals discuss benefits and harms with a health care professional.CONCLUSIONS AND RELEVANCE Information on public-facing websites of US lung cancer screening programs appears to lack balance with respect to portrayal of potential benefits and harms of screening. Important harms, such as overdiagnosis, were commonly ignored in the sites evaluated, and most of the centers did not explicitly guide individuals toward a guideline-recommended, shared decision-making discussion of harms and benefits.

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

Cited by 86 publications

References 39 publications

Meaningful shared decision‐making: complex process demanding cognitive and emotional skills

Meaningful shared decision‐making: complex process demanding cognitive and emotional skills

The Conundrum and Challenge of Lung Cancer Screening Shared Decision-making Implementation

Assessment of Lung Cancer Screening Program Websites

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