Shared Decision-Making for Lung Cancer Screening

Nishi, Shawn P.E.; Lowenstein, Lisa M.; Mendoza, Tito R.; Olivo, Maria A. Lopez; Crocker, Laura; Sepucha, Karen; Niu, Jiangong; Volk, Robert J.

doi:10.1016/j.chest.2021.01.041

Cited by 36 publications

(24 citation statements)

References 30 publications

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“…Please see elsewhere for a flow diagram of the recruitment process. 18 The final sample ( N = 264) was 52.0% male, with a mean age of 64.81. Majority (87.9%) of the participants were White, and 43.9% were college graduates.…”

Section: Resultsmentioning

confidence: 99%

“…A previous manuscript analyzing the same data set found there was no statistically significant difference in knowledge, SDMP_4 scores, and decisional conflict between groups based on time since last LCS (comparing less than 3 months, 3–6 months, and 6–12 months). 18 Hence, time since last screening was not included as a control in the analyses in this study.…”

Section: Discussionmentioning

confidence: 99%

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Impact of the shared decision‐making process on lung cancer screening decisions

et al. 2021

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Background: Professional organizations recommend the use of shared decisionmaking (SDM) in supporting patients' decisions about lung cancer screening (LCS). The objective of this study was to assess the impact of the SDM process on patient knowledge about LCS, decisional conflict, intentions to adhere to screening recommendations, and its role in how the patient made the final decision.Methods: This study surveyed patients screened for lung cancer within 12 months of the survey, recruited from two academic tertiary care centers in the South Central Region of the U.S. (May to July 2018).Results: Two hundred and sixty-four patients completed the survey (87.9% White, 52% male, and mean age of 64.81). Higher SDM process scores (which indicates a better SDM process reported by patients) were significantly associated with greater knowledge of LCS (b = 0.17 p < 0.01). Higher SDM process scores were associated with less decisional conflict about their screening choice (b = 0.45, p < 0.001), greater intentions to make the same decision again (OR = 1.42, 95% CI = [1.06-1.89]), and greater intentions to undergo LCS again (OR = 1.32, 95% CI = [1.08-1.62]). The SDM process score was not associated with patients' report of whether or not they shared the final decision with the healthcare provider (OR = 1.07, 95% CI = [0.85-1.35]). Conclusion(s):This study found that a better SDM process was associated with better affective-cognitive outcomes among patients screened for lung cancer.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of the shared decision‐making process on lung cancer screening decisions

et al. 2021

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“…Unique to LCS enrollment is the CMS-required and reimbursed counseling encounter for shared decision-making (SDM) [4,[6][7][8][9][10][11]. SDM is a fundamental tenet of LCS, intended to ensure that an individual's preferences are incorporated into the LCS decision through a balanced discussion of an individual's risk versus benefits [10].…”

Section: Introductionmentioning

confidence: 99%

“…Despite the CMS requirement regarding SDM, limited evidence suggests that SDM is underused, inconsistently used, and of variable quality, with rates as low as 9% [6,9,11,13,14]. Direct and robust evidence from LCS programs evaluating the components of and factors associated with SDM are lacking.…”

Section: Introductionmentioning

confidence: 99%

Prospective Multisite Cohort Study to Evaluate Shared Decision-Making Utilization Among Individuals Screened for Lung Cancer

Tailor

Rivera

Durham

et al. 2022

Journal of the American College of Radiology

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“… 38 , 39 , 40 However, multiple studies have shown that physicians tend to overemphasize the benefits of LCS with little mention of harms, do not use decision aids to facilitate patient understanding, and do not routinely explore patients’ values and preferences about LCS, all of which can hinder informed, values-based, and patient-centered decisions. 38 , 41 , 42 , 43 Our study suggests that physician-dependent preferences and varying facility structures and processes (eg, centralized screening programs, LCS coordinators) may affect the decision to screen more than patient-specific factors. Future work is needed to determine which facility- and physician-level factors underlie this variation and to explore opportunities for improving patient-centered shared decision-making.…”

Section: Discussionmentioning

confidence: 88%

Factors Associated With Declining Lung Cancer Screening After Discussion With a Clinician in a Cohort of US Veterans

et al. 2022

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ImportanceLung cancer screening (LCS) is underused in the US, particularly in underserved populations, and little is known about factors associated with declining LCS. Guidelines call for shared decision-making when LCS is offered to ensure informed, patient-centered decisions.ObjectiveTo assess how frequently veterans decline LCS and examine factors associated with declining LCS.Design, Setting, and ParticipantsThis retrospective cohort study included LCS-eligible US veterans who were offered LCS between January 1, 2013, and February 1, 2021, by a physician at 1 of 30 Veterans Health Administration (VHA) facilities that routinely used electronic health record clinical reminders documenting LCS eligibility and veterans’ decisions to accept or decline LCS. Data were obtained from the Veterans Affairs (VA) Corporate Data Warehouse or Medicare claims files from the VA Information Resource Center.Main Outcomes and MeasuresThe main outcome was documentation, in clinical reminders, that veterans declined LCS after a discussion with a physician. Logistic regression analyses with physicians and facilities as random effects were used to assess factors associated with declining LCS compared with agreeing to LCS.ResultsOf 43 257 LCS-eligible veterans who were offered LCS (mean [SD] age, 64.7 [5.8] years), 95.9% were male, 84.2% were White, and 37.1% lived in a rural zip code; 32.0% declined screening. Veterans were less likely to decline LCS if they were younger (age 55-59 years: odds ratio [OR], 0.69; 95% CI, 0.64-0.74; age 60-64 years: OR, 0.80; 95% CI, 0.75-0.85), were Black (OR, 0.80; 95% CI, 0.73-0.87), were Hispanic (OR, 0.62; 95% CI, 0.49-0.78), did not have to make co-payments (OR, 0.92; 95% CI, 0.85-0.99), or had more frequent VHA health care utilization (outpatient: OR, 0.70; 95% CI, 0.67-0.72; emergency department: OR, 0.86; 95% CI, 0.80-0.92). Veterans were more likely to decline LCS if they were older (age 70-74 years: OR, 1.27; 95% CI, 1.19-1.37; age 75-80 years: OR, 1.93; 95% CI, 1.73-2.17), lived farther from a VHA screening facility (OR, 1.06; 95% CI, 1.03-1.08), had spent more days in long-term care (OR, 1.13; 95% CI, 1.07-1.19), had a higher Elixhauser Comorbidity Index score (OR, 1.04; 95% CI, 1.03-1.05), or had specific cardiovascular or mental health conditions (congestive heart failure: OR, 1.25; 95% CI, 1.12-1.39; stroke: OR, 1.14; 95% CI, 1.01-1.28; schizophrenia: OR, 1.87; 95% CI, 1.60-2.19). The physician and facility offering LCS accounted for 19% and 36% of the variation in declining LCS, respectively.Conclusions and RelevanceIn this cohort study, older veterans with serious comorbidities were more likely to decline LCS and Black and Hispanic veterans were more likely to accept it. Variation in LCS decisions was accounted for more by the facility and physician offering LCS than by patient factors. These findings suggest that shared decision-making conversations in which patients play a central role in guiding care may enhance patient-centered care and address disparities in LCS.

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Shared Decision-Making for Lung Cancer Screening

Cited by 36 publications

References 30 publications

Impact of the shared decision‐making process on lung cancer screening decisions

Impact of the shared decision‐making process on lung cancer screening decisions

Prospective Multisite Cohort Study to Evaluate Shared Decision-Making Utilization Among Individuals Screened for Lung Cancer

Factors Associated With Declining Lung Cancer Screening After Discussion With a Clinician in a Cohort of US Veterans

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