Impact of a Lung Cancer Screening Counseling and Shared Decision-Making Visit

doi:10.1016/j.chest.2016.10.027

CHEST

Volume 151, Issue 3, March 2017, Pages 572-578

https://doi.org/10.1016/j.chest.2016.10.027 Get rights and content

Background

Lung cancer screening is a complex balance of benefits and harms. A counseling and shared decision-making visit has been mandated to assist patients with the decision about participation in screening. To our knowledge, the impact of this visit on patient understanding and decisions has not been studied.

Methods

We developed a centralized counseling and shared decision-making visit for our lung cancer screening program. The visit included confirmation of eligibility for screening, education supported by a narrated slide show, individualized risk assessment with a decision aid, time for answering questions, and data collection. We surveyed consecutive patients prior to the visit, immediately after the visit, and 1 month after the visit to determine the impact of the visit on their knowledge.

Results

Twenty-three of 423 patients (5.4%) who had a visit did not proceed to the screening CT scan. One hundred twenty-five consecutive patients completed the initial survey, 122 completed the postvisit survey, and 113 completed the 1-month follow-up survey. Prior to the visit, the patients had a poor level of understanding about the age and smoking eligibility criteria (8.8% and 13.6% correct, respectively) and the benefits and harms of screening (55.2% and 38.4% correct, respectively). There was a significant improvement in knowledge noted after the visit for all questions (P = .03 to P < .0001). Knowledge waned by the 1-month follow-up but remained higher than it was before the visit.

Conclusions

A centralized counseling and shared decision-making visit impacts the patient's knowledge about the eligibility criteria, benefits, and harms of lung cancer screening with LDCT, helping patients make value-based decisions.

Section snippets

Methods

Beginning April 1, 2015, we began face-to-face counseling and shared decision-making visits with patients referred to our lung cancer screening program. Patients were identified as potentially eligible for screening by their primary care or specialty provider. The screening program reviewed the patient’s electronic medical record (EMR) to confirm that they met screening program eligibility criteria. All eligible patients were scheduled for their counseling and shared decision-making visit, with

Results

Four hundred twenty-three patients had a shared decision-making visit between April 2015 and April 2016. Of these patients, 23 (5.4%) did not go on to have the LDCT examination. Eleven of the 23 patients chose not to proceed after completing the visit. Nine of the 23 patients did not meet our criteria for screening (seven by smoking history and one by age; one had undergone a CT examination within the past 12 months), and three were symptomatic (two had weight loss, one had chest pain). One

Discussion

This project had a goal of determining the impact of a lung cancer screening counseling and shared decision-making visit on patient understanding of the benefits and harms of screening and their decision about whether or not to complete the screening examination. We found that a small but not insignificant proportion of patients did not proceed to the screening examination (5.4%), either because of ineligibility or choice. We also found a generally poor level of understanding of the eligibility

Conclusions

A centralized counseling and shared decision-making visit appears to impact knowledge about the eligibility criteria, benefits, and harms of lung cancer screening with LDCT. The visit was capable of helping patients across a spectrum of educational levels make value-based decisions.

Acknowledgments

Author contributions: P. J. M. is the guarantor of the paper. P. J. M. takes responsibility for the integrity of the data and the accuracy of the data analysis. P. J. M. assumes full responsibility for the integrity of the submission as a whole, from inception to published article. A. T., H. P., M. S., and C. L. made substantial contributions to the study design, data collection and interpretation, and writing of the manuscript. X. W. and X. H. made substantial contributions to the study

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: FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

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CHEST

Original Research: Lung CancerImpact of a Lung Cancer Screening Counseling and Shared Decision-Making Visit

Background

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Conclusions

Acknowledgments

Chest

Chest

J Thorac Oncol

Chest

Chest

J Thorac Oncol

Benefits and harmss of CT screening for lung cancer: a systematic review

JAMA

American Cancer Society lung cancer screening guidelines

CA Cancer J Clin

US Preventive Services Task Force. Screening for lung cancer: US Preventive Services Task Force recommendation statement

Ann Intern Med

Original Research: Lung Cancer
Impact of a Lung Cancer Screening Counseling and Shared Decision-Making Visit