Shared Decision-making Visits Improved Comfort With Lung Cancer Screening Decisions

An oncologist reviews test results.
An oncologist reviews test results.

A shared decision-making visit was associated with better understanding of the eligibility, harms, and benefits in patients considering lung cancer screening with low-dose CT, according to a study published in Chest.1 

“We found a generally poor level of understanding of the eligibility criteria, benefits, and harms of screening upon entry into the program. This understanding improved substantially after the visit at the time of the decision about whether or not to proceed with screening. Patients generally felt the messages were delivered at an appropriate level and felt more comfortable about their decision after the visit,” said lead investigator Peter J. Mazzone, MD, MPH, in a news release.2

According to the paper, the benefits of low-dose CT screening for lung cancer outweigh the harms. Combining evidenced-based guidelines with the patient's preferences and values is a collaborative process known as shared decision-making. 

Investigators at Lung Cancer Screening Program at the Cleveland Clinic sought to understand the impact of a counseling and shared decision-making visit on a patient's understanding and decisions about lung cancer screening. The visit consisted of eligibility for lung cancer screening determination, education, risk assessment, time for questions to be addressed, and collection of data. Participants were surveyed before and after the visit and at 1-month follow-up to assess their knowledge.

Participants were found to have a poor understanding of eligibility for lung cancer screening based on age and smoking history (8.8% and 13.6% correct, respectively) prior to the visit. Furthermore, there was limited understanding of the harms and benefits of lung cancer screening (38.4% and 55.2% correct, respectively) prior to the visit.

After the visit, patients showed significant improvement in their understanding for all questions (P =.03 to P <.0001) though their knowledge declined some at the 1-month follow-up.1

“Screening presents a unique challenge to this balance as a minority of patients screened will experience the benefit while all have the potential to be harmed. All patients are presumably healthy at the time of screening. In addition, the fulcrum of this balance shifts based on how an individual patient values each side of the balance,” Mazzone stated in the news release.2

References

1. Mazzone PJ, Tenenbaum A, Seeley M, et al. Impact of a lung cancer screening counseling and shared decision-making visit. Chest. 2017;151(3):572-578.

2. To screen or not to screen for lung cancer? Counseling and shared decision-making visit helps high-risk individuals decide [news release]. Glenview, IL: Elsevier; March 13, 2017. https://www.elsevier.com/about/press-releases/research-and-journals/to-screen-or-not-to-screen-for-lung-cancer-counseling-and-shared-decision-making-visit-helps-high-risk-individuals-decide. Accessed March 20, 2017.

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