Evaluations of Implementation at Early-Adopting Lung Cancer Screening Programs

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

“…Clinicians from all sites reported challenges in achieving SDM, which may reflect a learning curve as hospitals struggle to implement this new and complex preventive health intervention. 16,17 Barriers to SDM in other contexts have been well-described and many are similar for LCS: clinicians reported limited time for SDM in the face of competing priorities, lacked risk communication skills, and perceived that patients do not always want to engage in SDM. 12,16,18 The CMS policy to reimburse a separate SDM visit may help mitigate the barrier of limited time and competing priorities during clinical visits, 10,16 but such reimbursement incentives do not always succeed.…”

“…14,29,30 LCS coordinators typically have more time to spend with patients and greater familiarity with the process and trade-offs of LCS, as well as available decision aids, than clinicians who have other competing clinical concerns to address. 17 Empowering coordinators to conduct SDM has helped foster SDM in other LCS programs and is supported by CMS reimbursement policies if the coordinator is a midlevel provider or clinical nurse specialist. 13,[31][32][33] Regardless of which clinician conducts SDM and that individual's risk communication skills, making decision aids available at the point of care may help foster clear communication about LCS.…”

COUNTERPOINT: Can Shared Decision-Making of Physicians and Patients Improve Outcomes in Lung Cancer Screening? No

“…Despite multiple recommendations to screen eligible patients, [2][3][4] uptake has been slow. 17,18 There are multiple reasons for this slow uptake, [18][19][20][21][22] but the hurdle of requiring a formal shared decision-making process is undoubtedly one cause. For instance, 75% of PCPs reported in a national survey that the benefits of screening outweigh the harms but only 5% had actually billed CMS for a shared decision-making visit.…”

Progress in the Management of Early-Stage Non–Small Cell Lung Cancer in 2017

“…Several investigators have identified knowledge gaps for health care providers regarding LCS, and these areas should be viewed as opportunities for future educational efforts. [29][30][31][32][33][34] With regard to patients, there are gaps in awareness of screening criteria and availability. 35 A pragmatic trial is currently underway to investigate the impact of patient navigation on screening adherence, patient-reported barriers, psychosocial concerns, and smoking cessation.…”