Despite recommendations, shared decision-making for lung cancer screening in practice may be far from what is intended by guidelines.
Shared decision-making (SDM) for lung cancer screening (LCS) with low-dose CT as per the U.S. Preventive Services Task Force recommendations seem to fall short, according to a study published in JAMA Internal Medicine.
Researchers from the University of North Carolina School of Medicine at Chapel Hill sought to assess the quality of SDM about the initiation of LCS in clinical practice in a small study of 14 patients. The patients’ mean age was 63.9 years. Nine patients were women. Seven patients had Medicare and eight patients were current smokers.
The analysis was based on transcribed conversations between primary care or pulmonary care physicians and patients presumed to be eligible for LCS. The researchers used 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 zero 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.
The results showed half the conversations were conducted by primary care physicians. The mean total OPTION score for the 14 LCS conversations was six on a scale of zero to 100 (range, 0-17). None of the conversations met the minimum skill criteria for eight of the 12 SDM behaviors. Physicians universally recommended LCS.
The researchers noted that discussions of harms, including false positives and their sequelae or overdiagnosis, was virtually absent from the conversations. The mean total visit length of a discussion was 13:07 minutes and the mean time spent discussing LCS was 0:59 minutes, 8 percent of the total visit time. There was no evidence that decision aids or other patient education materials for LCS were used.
The researchers concluded that based on the 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.