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Outcomes of Shared Decision-Making for Low-Dose Screening for Lung Cancer in an Academic Medical Center

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Abstract

Shared decision-making (SDM) helps patients weigh risks and benefits of screening approaches. Little is known about SDM visits between patients and healthcare providers in the context of lung cancer screening. This study explored the extent that patients were informed by their provider of the benefits and harms of lung cancer screening and expressed certainty about their screening choice. We conducted a survey with 75 patients from an academic medical center in the Southeastern U.S. Survey items included knowledge of benefits and harms of screening, patients’ value elicitation during SDM visits, and decisional certainty. Patient and provider characteristics were collected through electronic medical records or self-report. Descriptive statistics, Kruskal–Wallis tests, and Pearson correlations between screening knowledge, value elicitation, and decisional conflict were calculated. The sample was predominately non-Hispanic White (73.3%) with no more than high school education (53.4%) and referred by their primary care provider for screening (78.7%). Patients reported that providers almost always discussed benefits of screening (81.3%), but infrequently discussed potential harms (44.0%). On average, patients had low knowledge about screening (score = 3.71 out of 8) and benefits/harms. Decisional conflict was low (score = − 3.12) and weakly related to knowledge (R= − 0.25) or value elicitation (R= − 0.27). Black patients experienced higher decisional conflict than White patients (score = − 2.21 vs − 3.44). Despite knowledge scores being generally low, study patients experienced low decisional conflict regarding their decision to undergo lung cancer screening. Additional work is needed to optimize the quality and consistency of information presented to patients considering screening.

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Data Availability

All data and materials as well as software application or custom code support published claims and comply with field standards.

Code Availability

Available upon request to the corresponding author.

Abbreviations

EHR:

Electronic health record

CMS:

Centers for Medicare and Medicaid Services

KW:

Kruskal–Wallis

LDCT:

Low-dose computed tomography

REDCap:

Research Electronic Data Capture system

SD:

Standard deviation

SDM:

Shared decision-making

USPSTF:

US Preventive Services Task Force

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Acknowledgements

The authors wish to thank Ms. Erica Sercy for her editorial guidance and edits.

Funding

This study was funded through an institutional grant from the University of South Carolina Office of the Vice President for Research.

Author information

Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene St., Columbia, SC, 29208, USA

    Jan M. Eberth & Anja Zgodic

  2. Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, USA

    Jan M. Eberth & Anja Zgodic

  3. Wake Forest School of Medicine, Winston-Salem, NC, USA

    Scott C. Pelland & Stephanie Y. Wang

  4. Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA

    David P. Miller

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  1. Jan M. Eberth
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  4. Stephanie Y. Wang
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  5. David P. Miller
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Contributions

All members of the research team contributed to the review and editing of the manuscript. In addition, authors contributed to study conceptualization (AZ, JME, DM), data curation (SP, SW, AZ), formal analysis (AZ), methodology (AZ, JME, DM), funding acquisition (JME), project administration (JME, DM), supervision (JME, DM), visualization (AZ), and original draft writing (JME, AZ, DM).

Corresponding author

Correspondence to Jan M. Eberth.

Ethics declarations

Ethics Approval

The study was approved under expedited review (45 CFR 46 — categories #5 and #7) by the Institutional Review Boards of the University of South Carolina and of Wake Forest University.

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare no competing interests.

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Previous Abstract Presentation

Selected components of this research were presented at the North Carolina Chapter of the American College of Physician Annual Meeting (February 2021).

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Eberth, J.M., Zgodic, A., Pelland, S.C. et al. Outcomes of Shared Decision-Making for Low-Dose Screening for Lung Cancer in an Academic Medical Center. J Canc Educ 38, 522–537 (2023). https://doi.org/10.1007/s13187-022-02148-w

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