Patients’ Attitudes Regarding Lung Cancer Screening and Decision Aids. A Survey and Focus Group Study

Abstract

Vulnerable patients find lung cancer screening decision aids helpful and generally show increased knowledge after reviewing decision aids, particularly of harms. Our results can inform future implementation efforts.

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

“…19 One of the most challenging barriers to achieving SDM may be the impression that some clinicians hold that patients cannot understand or do not want to discuss complex LCS trade-offs, especially potential harms. 14,18 Some studies suggest that individuals with lower education levels have misconceptions about LCS even after reviewing decision aids 20 and engaging in SDM, 13 highlighting the need for improved interventions to promote patient understanding. On the other hand, in our sample of patients served by VA and safety net hospitals (both socioeconomically disadvantaged populations in which many patients have limited health literacy 21,22 ), participants expressed a desire to know more about the rationale, process, and outcomes of LCS, and some were frustrated when clinicians had not communicated this information.…”

“…20,34,35 Patients, including those with low literacy, value receiving clear LCS information from a decision aid, particularly when reviewed with a clinician. 12,20,34,36,37 In particular, preparing patients for the possibility of a screen-detected nodule and the work-up that might ensue through clear, patient-centered communication may help mitigate future distress patients may experience if a nodule is found. 38 In real-world settings, higher quality communication about incidental pulmonary nodules is associated with lower distress and improved adherence to evaluation.…”

POINT: Can Shared Decision-Making of Physicians and Patients Improve Outcomes in Lung Cancer Screening? Yes

“…Just as in other clinical contexts, patients facing the decision about whether to be screened generally welcome learning about the trade-offs of LCS to make a more informed choice about whether to undergo screening. [5][6][7] Different patients do value the trade-offs of LCS differently, 8 and rates of accepting LCS range from 34% to 95% after learning about LCS trade-offs through an SDM process. 9,10 Recognizing the potential for both benefit and harm of LCS and following the example of guidelines for other cancer screenings, it is not surprising that several organizations, including the US Preventive Services Task Force, recommend SDM for LCS.…”

“…Pre-post studies show that reviewing an LCS decision aid improves knowledge, reduces decisional conflict, and increases decisions consistent with the individual's values and preferences. 5,[15][16][17] Studies of actual SDM encounters for LCS, at least when conducted in a dedicated visit with LCS screening program personnel, also result in improved knowledge, low decisional conflict, and high satisfaction. 10,18 Of note, no study has yet examined longer term outcomes of SDM for LCS, but SDM seems to improve adherence to testing in the context of other cancer screenings.…”

Rebuttal From Dr Wiener

“…6 And as Dr Slatore notes, the CMS policy may be excessive in its emphasis on information sharing, including a long list of items to be discussed, which can overwhelm some patients. 7,8 The most effective strategy to increase uptake of high-quality SDM in clinical practice is unclear, 9 and thus it does not make sense for the CMS policy to be so rigid in specifying how SDM for LCS must be implemented. I know Dr Slatore will agree with me that studies to test both the effectiveness of and the optimal strategies to implement SDM for LCS in clinical practice are sorely needed.…”