Telephone-Based Shared Decision-making for Lung Cancer Screening in Primary Care

Abstract

The national rate of lung cancer screening, approximately 3-5%, is too low and strategies which include shared decision-making and increase screening are needed. A feasibility study in one large primary care practice of telephone-based delivery of decision support via an online tool, the Decision Counseling Program© (DCP) was administered to patients eligible for lung cancer screening according to USPSTF screening guidelines. We collected data on demographics, decisional conflict, and conducted chart audits to ascertain screening. From electronic medical record data, we identified 829 age-eligible current or former smokers. Of the 297 individuals reached, 54 were eligible and 28 were recruited to the study and 20 underwent the DCP© intervention. Participants in the intervention were more likely to complete low-dose CT scans at 90 days. Current smokers were less likely to complete the DCP. Women were less likely to complete LDCT. This non-persuasive, high-quality shared decision-making intervention significantly increased lung cancer screening and was feasible in real-world clinical care. This intervention offers a promising model whereby patients can be supported in a decision, based on their values and beliefs while also supporting gains in lung cancer screening.

Motivation is not enough: A qualitative study of lung cancer screening uptake in Australia to inform future implementation

“…While low self-efficacy may be an anticipated finding in the high-risk population who are 'hard to reach' it remains challenging to build individual's belief in their capacity to undertake screening in a population setting. Recently, innovation to increase screening attendance following a telephone-based delivery of decision support via an online tool has been reported [41]. Additionally, a reminder letter providing a pre-scheduled appointment increased uptake of LCS among non-responders in a UK trial, although there were no statistically significant differences across control and intervention groups [42].…”

Telemedicine Across the Cancer Care Continuum

“…5 To our knowledge, evidence regarding the use of telemedicine in cancer screening has been limited, mainly focusing on asynchronous methods such as text messages or reminder letters to promote update of screening, although telephone-based cancer screening educational and shared decision-making interventions achieving positive outcomes have been described. [6][7][8][9] While asynchronous telemedicine, such as digital evaluation of skin lesions, may expedite a cancer diagnosis, it is quite unlikely that telemedicine approaches alone are sufficient to diagnose cancer. Virtual consultations for the assessment and management of patients in oncology settings may be feasible, although evidence is limited.…”

Lung Cancer Screening Policy in Alaska and Occupational Therapy

“…Possible solutions are group LDCT lung cancer screening education classes taught by designated clinical specialists (Sakoda et al, 2019) and telephone-based decision counseling (Fagan et al, 2020). Although occupational therapy practitioners cannot currently bill for LDCT lung cancer screening, they have the potential, with proper education in such screening, to become designated clinical specialists to carry out SDM conversations.…”