The Importance of Lung Cancer Screening With Low-Dose Computed Tomography for Medicare Beneficiaries

Wood, Douglas E.

doi:10.1001/jamainternmed.2014.5623

Cited by 12 publications

(6 citation statements)

References 12 publications

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“…Smoking cessation programs should be regarded as a mandatory strategy within screening and should be extensively implemented in countries in which screening will be applied to general population, such as the United States. 31 On the basis of our results, we suggest that a smoking cessation program could be the optimal strategy to reduce mortality due to SCLC, which is closely related to active smoking 2 and shows a progressive decrease in risk by the time of quitting smoking. 32 Therefore, a smoking intervention forearm of LDCT screening along with the use of active drugs such as varenicline should be considered.…”

Section: Discussionmentioning

confidence: 72%

Screening with Low-Dose Computed Tomography Does Not Improve Survival of Small Cell Lung Cancer

Silva

Galeone

Sverzellati

et al. 2016

Journal of Thoracic Oncology

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Section: Discussionmentioning

confidence: 72%

Screening with Low-Dose Computed Tomography Does Not Improve Survival of Small Cell Lung Cancer

Silva

Galeone

Sverzellati

et al. 2016

Journal of Thoracic Oncology

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“…Although experts disagree on how well the existing evidence suggests an overall net benefit of LCS, consensus has emerged on the importance of shared decision making (SDM). The USPSTF recommends that LCS should not be initiated without SDM that involves a thorough discussion of its benefits and harms.…”

Section: Introductionmentioning

confidence: 99%

Evaluating Shared Decision Making for Lung Cancer Screening

et al. 2018

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recommends that shared decision making (SDM) involving a thorough discussion of benefits and harms should occur between clinicians and patients before initiating lung cancer screening (LCS) with low-dose computed tomography. The Centers for Medicare & Medicaid Services require an SDM visit using a decision aid as a prerequisite for LCS coverage. However, little is known about how SDM about LCS occurs in practice. OBJECTIVE To assess the quality of SDM about the initiation of LCS in clinical practice. DESIGN, SETTING, AND PARTICIPANTS A qualitative content analysis was performed of transcribed conversations between primary care or pulmonary care physicians and 14 patients presumed to be eligible for LCS, recorded between April 1, 2014, and March 1, 2018, that were identified within a large database. MAIN OUTCOMES AND MEASURES Independent observer ratings of communication behaviors of physicians using the OPTION (Observing Patient Involvement in Decision Making) scale, a validated 12-item measure of SDM (total score, 0-100 points, where 0 indicates no evidence of SDM and 100 indicates evidence of SDM at the highest skill level); time spent discussing LCS during visits; and evidence of decision aid use. RESULTS A total of 14 conversations about initiating LCS were identified; 9 patients were women, and 5 patients were men; the mean (SD) patient age was 63.9 (5.1) years; 7 patients had Medicare, and 8 patients were current smokers. Half the conversations were conducted by primary care physicians. The mean total OPTION score for the 14 LCS conversations was 6 on a scale of 0 to 100 (range, 0-17). None of the conversations met the minimum skill criteria for 8 of the 12 SDM behaviors. Physicians universally recommended LCS. Discussion of harms (such as false positives and their sequelae or overdiagnosis) was virtually absent. The mean total visit length of a discussion was 13:07 minutes (range, 3:48-27:09 minutes). The mean time spent discussing LCS was 0:59 minute (range, 0:16-2:19 minutes), or 8% of the total visit time (range, 1%-18%). There was no evidence that decision aids or other patient education materials for LCS were used. CONCLUSIONS AND RELEVANCE In this small sample of recorded encounters about initiating LCS, the observed quality of SDM was poor and explanation of potential harms of screening was virtually nonexistent. Time spent discussing LCS was minimal, and there was no evidence that decision aids were used. Although these findings are preliminary, they raise concerns that SDM for LCS in practice may be far from what is intended by guidelines.

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“…In all three rounds, a higher rate of positive screening test results was found with LDCT than with CXR. About 320 high-risk smokers or former smokers would need to be screened for every life saved, which compares well with other screening tests-to save one life from breast cancer, 2,000 people have to be screened; for colon cancer, 1,200 people [8]. However, false positive rates for these other tests are much lower.…”

Section: Evidence and Guidelinesmentioning

confidence: 97%

Close-Call Screening and Shared Decision Making

Chan

2015

AMA Journal of Ethics

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The Importance of Lung Cancer Screening With Low-Dose Computed Tomography for Medicare Beneficiaries

Cited by 12 publications

References 12 publications

Screening with Low-Dose Computed Tomography Does Not Improve Survival of Small Cell Lung Cancer

Screening with Low-Dose Computed Tomography Does Not Improve Survival of Small Cell Lung Cancer

Evaluating Shared Decision Making for Lung Cancer Screening

Close-Call Screening and Shared Decision Making

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