3 lessons for providing patient-centered care through a lung cancer screening program

Screening programs give radiologists a chance to interact directly with patients, demonstrating their value to the entire healthcare enterprise. Researchers from Weill Cornell Imaging at New York-Presbyterian in New York City, for instance, implemented a CT-based lung cancer screening program at their own institution and wrote about their experience in the American Journal of Roentgenology.

“With the success of the breast cancer screening model and recognition of the radiologist's role in educating the public on imaging-based cancer screening, lung cancer screening programs afford a clear opportunity for radiologists to meet, consult with, and educate patients,” wrote lead author James F. Gruden, MD, department of radiology at Weill Cornell Imaging at NewYork-Presbyterian, and colleagues. “The exact nature of this interaction depends on preferences of both the individual patient and the referring physician and on the specifics of the interaction (consultative or results reporting and discussion).”

These are three key lessons the authors learned along the way:

1. Programs need a full-time coordinator

A full-time coordinator, the authors explained, can oversee the entire lung cancer screening program. They are a patient’s chief contact, helping them along the entire process and helping them understand “terminology and possible outcomes.”

“The program coordinator should have a background in social work, public health, or nursing (registered nurse or nurse practitioner) or as a physician assistant,” the authors wrote. “One important advantage of a physician assistant or nurse practitioner with respect to the others is the ability to order baseline and follow-up imaging and to bill for consultative services.”

This individual also helps manage a patient’s expectations, making sure they understand that the screening will reduce their risk of dying of lung cancer, but it won’t completely eliminate it altogether.

2. Shared decision-making is a perfect time for radiologist-patient communication

Medicare coverage for a shared decision-making (SDM) session is provided by CMS, making it the perfect time for radiologists to interact with patients.

“SDM is a collaboration between a patient and a clinician designed to assist patients in making the best decisions for their care,” the authors wrote. “The objectives of SDM are to ensure that patients understand the significance of lung cancer; understand the specific preventive services (CT in this case), including risks, benefits, and alternatives; and feel comfortable deciding whether to participate in screening.”

Decision aids such as handouts are distributed at this time, allowing the radiologist to go over all of the information and answering questions.

3. Know the best way to share screening results with each patient

When the baseline scans fall into Lung CT Screening Reporting and Data System (Lung-RADS) category 1 or 2, the authors explained, that news should be delivered “as quickly as possible” to reduce any anxiety. This covered more than 80 percent of the program’s patients. When a patient’s results fall into Lung-RADS category 3, meanwhile, the low risk of malignancy is emphasized and radiologists explain that if a nodule does become a cancer, it can still be detected at an early stage.

When the findings are more serious, the care team should work together to deliver that news in the best manner possible. “An encounter with a patient with a suspicious nodule (Lung-RADS category 4) is the most challenging and usually the most time-consuming,” the authors wrote. “The program coordinator, who is familiar with the patient from the preimaging evaluation, can offer valuable insight to the radiologist as to how to best to approach the specific patient before the actual consultation occurs. Some patients prefer limited and basic information, but others prefer a more direct and thorough discussion.”