The U.S. Preventive Services Task Force recommends that physicians and patients take part in shared decision-making about both the benefits and the harms associated with lung cancer screening with low-dose CT (LDCT). According to a new study published in JAMA Internal Medicine, however, the quality of shared decision making in today’s healthcare environment is quite low.
The authors analyzed audio from 14 different doctor-patient conversations about lung cancer screening with LDCT. Seven of the patients had Medicare, and eight were current smokers.
Overall, the discussion were “brief and one-sided” and discussions about the specific harms associated with screening were “virtually absent.” Lung cancer screening was discussed for an average of 59 seconds, and the shortest amount of time it was discussed was just 16 seconds.
“We’re not taking a side as to whether lung cancer screening is good or bad, but there seems to be a consensus that we should be sharing these complex decisions with patients,” senior author Daniel Reuland, MD, MPH, director of the University of North Carolina Lineberger Comprehensive Cancer Center’s Carolina Cancer Screening Initiative, said in a news release from the school. “Our fly-on-the-wall sample from real-world practice shows us that’s not happening.”
Reuland noted that deciding to take part in lung cancer screening with LDCT is a fairly complex choice, and patients have a lot to consider.
“The problem is weighing a small chance of benefit in the form of prolonged life versus a larger chance that a given patient will incur some kind of physical or psychological harm, plus out-of-pocket costs,” he said in the same release. “It’s important to talk about those potential harms and benefits with patients when deciding about screening.”
To help shared decision making improve, Reuland said, providers need “better systems and infrastructure.” He added that it’s an important responsibility, one physicians must take seriously.
“Issuing guidelines and payer-based regulations saying we should be doing shared decision-making is fine, but it isn’t enough,” he said. “Among other things, we need more efficient and reliable ways of getting patients involved in these decisions.”
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.