TY - JOUR
T1 - Shared Decision-Making for Lung Cancer Screening
T2 - How Well Are We “Sharing”?
AU - Nishi, Shawn P.E.
AU - Lowenstein, Lisa M.
AU - Mendoza, Tito R.
AU - Lopez Olivo, Maria A.
AU - Crocker, Laura C.
AU - Sepucha, Karen
AU - Niu, Jiangong
AU - Volk, Robert J.
N1 - Funding Information:
FUNDING/SUPPORT: This study was supported by the Cancer Prevention and Research Institute of Texas [Grant RP160674 ] and the National Cancer Institute of the National Institutes of Health [Grant P30CA016672 ] and used the Shared Decision Making Core, Assessment, Intervention and Measurement Shared Resource and Clinical Protocol and Data Management; and by The University of Texas MD Anderson Cancer Center Duncan Family Institute for Cancer Prevention and Risk Assessment.
Publisher Copyright:
© 2021 American College of Chest Physicians
PY - 2021/7
Y1 - 2021/7
N2 - BACKGROUND: Lung cancer screening (LCS) reduces lung cancer mortality, but it also carries a range of risks. Shared decision-making (SDM) is a process of engaging patients in their health-care decisions and is a vital component of LCS.RESEARCH QUESTION: What is the quality of SDM among patients recently assessed for LCS?STUDY DESIGN AND METHODS: Cross-sectional study of screened patients recruited from two academic tertiary care centers in the South Central Region of the United States. Self-reported surveys assessed patient demographics, values related to outcomes of LCS, knowledge, SDM components including receipt of educational materials, and decisional conflict.RESULTS: Recently screened patients (n = 266) possessed varied LCS knowledge, answering an average of 41.4% of questions correctly. Patients valued finding cancer early over concerns about harms. Patients indicated that LCS benefits were presented to them by a health-care provider far more often than harms (68.3% vs 20.8%, respectively), and 30.7% reported they received educational materials about LCS during the screening process. One-third of patients had some decisional conflict (33.6%) related to their screening decisions, whereas most patients (86.6%) noted that they were involved in the screening decision as much as they wanted. In multivariate models, non-White race and having less education were related to lower knowledge scores. Non-White patients and former smokers were more likely to be conflicted about the screening decision. Most patients (n = 227 [85.3%]) indicated that a health-care provider had discussed smoking cessation or abstinence with them.INTERPRETATION: Among recently screened patients, the quality of decision-making about LCS is highly variable. The low use of educational materials including decision aids and imbalance of conveying benefit vs risk information to patients is concerning. A structured approach using decision aids may assist with providing a balanced presentation of information and may improve the quality of SDM.
AB - BACKGROUND: Lung cancer screening (LCS) reduces lung cancer mortality, but it also carries a range of risks. Shared decision-making (SDM) is a process of engaging patients in their health-care decisions and is a vital component of LCS.RESEARCH QUESTION: What is the quality of SDM among patients recently assessed for LCS?STUDY DESIGN AND METHODS: Cross-sectional study of screened patients recruited from two academic tertiary care centers in the South Central Region of the United States. Self-reported surveys assessed patient demographics, values related to outcomes of LCS, knowledge, SDM components including receipt of educational materials, and decisional conflict.RESULTS: Recently screened patients (n = 266) possessed varied LCS knowledge, answering an average of 41.4% of questions correctly. Patients valued finding cancer early over concerns about harms. Patients indicated that LCS benefits were presented to them by a health-care provider far more often than harms (68.3% vs 20.8%, respectively), and 30.7% reported they received educational materials about LCS during the screening process. One-third of patients had some decisional conflict (33.6%) related to their screening decisions, whereas most patients (86.6%) noted that they were involved in the screening decision as much as they wanted. In multivariate models, non-White race and having less education were related to lower knowledge scores. Non-White patients and former smokers were more likely to be conflicted about the screening decision. Most patients (n = 227 [85.3%]) indicated that a health-care provider had discussed smoking cessation or abstinence with them.INTERPRETATION: Among recently screened patients, the quality of decision-making about LCS is highly variable. The low use of educational materials including decision aids and imbalance of conveying benefit vs risk information to patients is concerning. A structured approach using decision aids may assist with providing a balanced presentation of information and may improve the quality of SDM.
KW - decision aids
KW - lung cancer screening
KW - shared decision-making
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U2 - 10.1016/j.chest.2021.01.041
DO - 10.1016/j.chest.2021.01.041
M3 - Article
C2 - 33556362
SN - 0012-3692
VL - 160
SP - 330
EP - 340
JO - Chest
JF - Chest
IS - 1
ER -