Stakeholder Research Priorities to Promote Implementation of Shared Decision-Making for Lung Cancer Screening: An American Thoracic Society and Veterans Affairs Health Services Research and Development Statement

Wiener, Renda Soylemez; Barker, Anna M; Carter‐Harris, Lisa; Caverly, Tanner J.; Crocker, David A.; Denietolis, Angela; Doherty, Colin P.; Fagerlin, Angela; Gallagher-Seaman, Mary; Gould, Michael K.; Han, Paul K. J.; Herbst, Abigail N; Fukunaga, Mayuko Ito; McCullough, Megan; Miano, Danielle; Quaife, Samantha L; Slatore, Christopher G.; Fix, Gemmae M.

doi:10.1164/rccm.202201-0126st

Cited by 10 publications

(5 citation statements)

References 60 publications

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“… 6 The goal of shared decision-making conversations is to educate patients about LCS and its harms and benefits, consider patients’ individual lung cancer risk, and incorporate patient preferences and values with regard to LCS to improve overall LCS uptake and patient-centered care. 51 In this cohort study, we found that the physician and site that offered LCS accounted for more variation in LCS decisions than did patient factors, suggesting a need to refocus shared decision-making conversations on the patient’s individual circumstances and standardize shared decision-making to minimize physician and facility variation. 13 At the patient level, older veterans with serious comorbidities were more likely to decline LCS, suggesting that competing health demands for these patients may have made LCS a low priority.…”

Section: Discussionmentioning

confidence: 82%

“…Lung cancer screening is underused in the US both inside and outside the VHA, in part owing to a lack of awareness of LCS among populations at risk . The goal of shared decision-making conversations is to educate patients about LCS and its harms and benefits, consider patients’ individual lung cancer risk, and incorporate patient preferences and values with regard to LCS to improve overall LCS uptake and patient-centered care . In this cohort study, we found that the physician and site that offered LCS accounted for more variation in LCS decisions than did patient factors, suggesting a need to refocus shared decision-making conversations on the patient’s individual circumstances and standardize shared decision-making to minimize physician and facility variation .…”

Section: Discussionmentioning

confidence: 89%

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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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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 89%

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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“…Shared decision making is important, involving participants and healthcare professions, the latter supporting the often complex cognitive and emotional demands 35 . It is recognised that decision support tools can improve overall knowledge scores, but eligibility, false positive and negative findings, and lung cancer mortality reduction remain poorly presented and misunderstood [36][37][38] . Thus, LCS programs need to be organised in a way that supports integration of shared decision making in lung screening.…”

Section: Supporting Equitable Participation In Lung Cancer Screeningmentioning

confidence: 99%

Defining the road map to a UK national lung cancer screening programme

O’Dowd

Lee

Akram

et al. 2023

The Lancet Oncology

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“…Standardization and embedding SDM within LCS programs can help to ensure SDM is provided by health care professionals who are knowledgeable and experienced (eg, LCS coordinators in centralized programs). The relaxing of CMS restrictions on SDM requirements in the 2022 CMS Decision Memo allows the opportunity to explore novel approaches, such as using other team members like decision coaches or community health workers to support SDM conversations or new formats such as group SDM visits or SDM by telehealth [8]. Additionally, wherever possible, health care systems could automate language and billing codes for screening to lessen the burden of documentation on clinicians and reimbursement on health care systems.…”

Section: Question 4: How Can We Improve Sdm and Utilization Of High-q...mentioning

confidence: 99%

“…A critical area for future research is how to conduct high-quality SDM conversations that meet the needs of patients and the health care team in very brief conversations (ie, what are the minimal essential elements to cover in a highquality SDM discussion?) [8].…”

Section: Question 4: How Can We Improve Sdm and Utilization Of High-q...mentioning

confidence: 99%

Doing Versus Documenting Shared Decision-Making for Lung Cancer Screening—Are They the Same?

Lewis

Wiener

Slatore

et al. 2022

Journal of the American College of Radiology

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Stakeholder Research Priorities to Promote Implementation of Shared Decision-Making for Lung Cancer Screening: An American Thoracic Society and Veterans Affairs Health Services Research and Development Statement

Cited by 10 publications

References 60 publications

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

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

Defining the road map to a UK national lung cancer screening programme

Doing Versus Documenting Shared Decision-Making for Lung Cancer Screening—Are They the Same?

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