Study uncovers inconsistencies, challenges in shared decision making about lung cancer screening
Clinicians were inconsistent in the information they shared with patients, while patients were not always receptive to deliberating together.
There may be room for improvement in guideline-recommended shared decision making about screening for lung cancer between clinicians and high-risk patients, a qualitative study found.
Researchers recruited participants from lung cancer screening programs at four sites: three Veterans Health Administration hospitals and one urban safety net hospital. Between October 2013 and June 2016, they interviewed 36 primary care clinicians, pulmonologists, and screening nurse coordinators who refer patients for lung cancer screening and 49 patients who were screened in the previous year. They then used interview transcripts to characterize communication and decision making about lung cancer screening with chest CT, focusing on the recommended components of and barriers to achieving shared decision making. Results were published online on Feb. 21 by the Journal of General Internal Medicine.
Clinicians were inconsistent in the information they shared with patients. While some reported offering a comprehensive description of lung cancer screening and providing a decision aid, others gave patients minimal information for various reasons, such as uncertainty regarding patients' comprehension, particularly about the potential harms of screening. Patients reported receiving a range of information. While some were aware of the rationale of screening, others didn't even realize that it was for cancer.
Regarding deliberation and decision making, clinicians reported such challenges as determining a patient's anticipated emotional reaction to potential surveillance of a nodule detected on screening. Others noted that patients are not always receptive to deliberating together. Patients noted similar barriers, although some reported successful deliberation and felt that their questions and concerns were addressed.
Clinicians had mixed reports about using decision aids. While some felt that they improved patient comprehension, especially with visual components, others found that providing specific risk information was a barrier to engaging patients. Most patients did not mention decision aids in their interviews, and those who did either found them helpful or excessively detailed.
The study authors noted limitations, such as the reliance on participants' recall of conversations and the potential bias of including only patients who had been screened for lung cancer. They added that they conducted interviews in the first few years after lung cancer screening was introduced at the sites.
“Communication and decision-making will likely continue to evolve as clinicians become more familiar with the evidence, guidelines, and policies surrounding [lung cancer screening], and public awareness of [lung cancer screening] rises,” they wrote.