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• W2908075416 abstract "FOR RELATED ARTICLE, SEE PAGE 21The decision to undergo lung cancer screening (LCS) is complex, and a shared decision-making (SDM) visit is essential. Although the Centers for Medicare & Medicaid Services requires an in-person visit, this approach may not be feasible for certain providers and patients due to constrained resources and logistical considerations.1Kanodra N.M. Pope C. Halbert C.H. Silvestri G.A. Rice L.J. Tanner N.T. Primary care provider and patient perspectives on lung cancer screening. A qualitative study.Ann Am Thorac Soc. 2016; 13: 1977-1982Crossref PubMed Scopus (82) Google Scholar We undertook the present study to determine the effect of an SDM visit delivered by two different methods on patient satisfaction and decisional conflict. FOR RELATED ARTICLE, SEE PAGE 21 This analysis was a prospective observational study. Eligible participants were recruited from the Medical University of South Carolina and the Ralph H. Johnson Veterans Affairs Hospital. Participants completed a self-administered baseline survey; underwent an SDM visit, which utilized a decision aid, either in person or over the telephone; and then completed a follow-up telephone survey 1 month later (e-Appendix 1). The effects of the SDM intervention were examined based on constructs from the Ottawa Decision Support Framework (Fig 1). Patient-provider communication, cultural beliefs and values, perceived benefits, and harms of LCS, decision impact, decision quality, and decision action were measured according to the survey. A total of 137 subjects (91%) completed the study and were included in the final analysis (Fig 2). There was no difference in age, race, socioeconomic status, or education between groups, although there were more male participants in the telephonic SDM group. Most participants (n = 104 [75.9%]) were in the highest category of risk (>2%) as calculated by using the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial Model 2012 with mean ± SD risk of 5.2 ± 4.2% of developing lung cancer in the next 6 years (Table 1).Table 1Demographic Characteristics and Decisional Satisfaction, Conflict, and Action According to SDM Visit Delivery Method (N = 137)VariableTotal (N = 137)In-person (n = 69)Telephone (n = 68)Age, mean ± SD, y64.7 ± 6.164.1 ± 6.0)65.2 ± 6.2SexaP < .01. Male97 (70.8)33 (47.8)64 (94.1) Female40 (29.2)36 (52.2)4 (5.9)Race NHW88 (64.2)45 (64.2)43 (63.2) NHB39 (28.5)20 (28.5)19 (27.9) Hispanic7 (5.1)3 (5.1)4 (5.9) American Indian2 (1.5)02 (2.9) Other1 (0.7)1 (1.5)0Marital status Married64 (46.7)28 (40.6)36 (52.9) Not married19 (13.9)12 (17.4)7 (10.3) Separated32 (23.4)13 (18.8)1 (1.5) Divorced17 (12.4)12 (17.4)19 (27.9) Widowed5 (3.7)4 (5.8)5 (7.4)Education < High school14 (10.2)9 (13.0)5 (7.4) High school41 (29.9)21 (30.4)20 (29.4) > High school56 (40.9)22 (31.9)34 (50.0) ≥ College26 (19.0)17 (24.6)9 (13.2)Employment Working24 (17.5)13 (18.8)11 (16.2) Not working78 (56.9)37 (53.6)41 (60.3) Unable to work35 (25.6)19 (27.5)16 (23.5)Household income (per year), $ 0-20,00039 (28.5)19 (27.5)20 (29.4) 20,000-40,00027 (19.7)10 (14.5)17 (25.0) 40,000-60,00025 (18.3)13 (18.8)12 (17.7) > 60,00031 (22.6)18 (26.1)13 (19.1) Refuse to answer15 (11.0)9 (13.0)6 (8.8)Family history of lung cancer34 (24.8)16 (23.2)18 (26.5)Individual risk, mean ± SD5.2 ± 4.25.2 ± 4.25.2 ± 3.9Individual risk (range)0.4-25.50.4-25.50.4-18.2Category of risk (PLCOm2012) Low (< 1%)5 (3.6)2 (2.9)3 (4.4) Intermediate (1% to < 2%)28 (20.4)15 (21.7)13 (19.1) High (> 2%)104 (75.9)52 (75.3)52 (76.5)Decisional satisfaction (maximum score 30), mean ± SD25.7 ± 4.526.7 ± 2.824.6 ± 5.6Decisional conflict (maximum score 20), mean ± SD11.7 ± 3.411.3 ± 3.412.1 ± 3.4Underwent LDCT scanning121 (88.3)61 (88.4)60 (88.2)Data are presented as frequency (%) unless otherwise indicated. LDCT = low-dose CT; NHB = non-Hispanic black; NHW = non-Hispanic white; PLCOm2012 = Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial Model 2012; SDM = shared decision-making.a P < .01. Open table in a new tab Data are presented as frequency (%) unless otherwise indicated. LDCT = low-dose CT; NHB = non-Hispanic black; NHW = non-Hispanic white; PLCOm2012 = Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial Model 2012; SDM = shared decision-making. Following SDM, 121 (88.3%) patients underwent LCS. There was no difference in the number who accepted screening between SDM groups (88.4% in-person vs 88.2% telephonic SDM; P = .98). Satisfaction with their decision about LCS was high in both the in-person group and the telephonic SDM group, and there was no difference between those accepting and declining screening. Similarly, decisional conflict was low among participants (Table 1). To our knowledge, this report is the first regarding decision quality following an SDM visit for LCS, and it adds to existing literature in several ways. First, using either method of SDM, decision quality and decision impact were high. Second, irrespective of their decision for or against screening, patients were highly satisfied, with little decisional conflict. Finally, after undergoing a structured SDM visit that provided individual risk for developing lung cancer, 88% choose to be screened. Given that only 4% of eligible patients in the United States were screened for lung cancer in 2015 with little change in the subsequent 2 years,2Jemal A. Fedewa S.A. Lung cancer screening with low-dose computed tomography in the United States-2010 to 2015.JAMA Oncol. 2017; 3: 1278-1281Crossref PubMed Scopus (342) Google Scholar, 3Green A.K. Bach P. Model-based eligibility for lung cancer screening: where theory meets practice.Ann Intern Med. 2018; 168: 223-224Crossref PubMed Scopus (7) Google Scholar novel approaches for patient outreach should be considered. Although the Centers for Medicare & Medicaid Services mandates an in-person SDM visit prior to LCS, it is unclear whether primary care providers understand the nuances of LCS, including eligibility, benefits, potential harms, and smoking cessation counseling.1Kanodra N.M. Pope C. Halbert C.H. Silvestri G.A. Rice L.J. Tanner N.T. Primary care provider and patient perspectives on lung cancer screening. A qualitative study.Ann Am Thorac Soc. 2016; 13: 1977-1982Crossref PubMed Scopus (82) Google Scholar Conducting an SDM visit over the telephone has the potential to improve logistics and convenience for patients. An LCS SDM visit that includes individual risk prediction and counseling regarding LCS results in high decisional quality and impact, regardless of the method of delivery. These findings suggest that alternative delivery methods could be used to increase access to shared-decision making for LCS as it is implemented across the United States." @default.
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• W2908075416 title "In-person and Telephonic Shared Decision-making Visits for People Considering Lung Cancer Screening" @default.
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• W2908075416 doi "https://doi.org/10.1016/j.chest.2018.07.046" @default.
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