Patient and Clinician Perspectives on Shared Decision-making in Early Adopting Lung Cancer Screening Programs: a Qualitative Study

Introduction: Lung cancer remains the leading cause of oncologic mortality in the United States. Computed tomography (CT) screening has begun to combat this prevalent health problem. Prior to enrollment, a shared decision-making conversation is required to ensure a patient preference decision. This is the first and only imaging study to hold this requirement and compliance has been suspected to be low, but there is limited literature proving this. Methods: At a single academic institution, 30 patients who declined and 38 patients who enrolled in CT lung cancer screening were interviewed about their shared decision-making provider conversation. All referring providers were surveyed regarding their methods of shared decision-making for CT lung cancer screening. Clinical notes were evaluated 9 months prior to 2 interventions and 6 months following the first intervention to improve clinical documentation. Results: 85% to 89% of the interviewed patients could not recall a decision aid used during the shared decision-making conversation. Zero percent of clinical notes met the Centers for Medicare/Medicaid Services (CMS) encounter requirements for shared decision-making despite interventions to improve knowledge and ease accessibility to decision aids and documentation templates. Discussion: Lack of compliance with CMS requirements has a low patient decision satisfaction. This also places the institution at risk for financial repercussions of reimbursement which may jeopardize the longevity of screening programs. Development of strategies to improve the patient experience and provider facilitation are nascent and require a dedicated leadership team with carefully constructed electronic health record support.

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Implementation of Shared Decision Making for Lung Cancer Screening Among the Privately Insured Nonelderly

MDM Policy & Practice ◽

10.1177/2381468320984773 ◽

2021 ◽

Vol 6 (1) ◽

pp. 238146832098477

Author(s):

Ya-Chen Tina Shih ◽

Ying Xu ◽

Lisa M. Lowenstein ◽

Robert J. Volk

Keyword(s):

Lung Cancer ◽

Decision Making ◽

Cancer Screening ◽

Shared Decision Making ◽

Private Insurance ◽

Lung Cancer Screening ◽

Shared Decision ◽

Factors Associated ◽

Coverage Policy ◽

Privately Insured

Introduction. The Centers for Medicare & Medicaid Services requires a written order of shared decision making (SDM) visit in its coverage policy for low-dose computed tomography (LDCT) for lung cancer screening (LCS). With screening eligibility starting at age 55, private insurance plans will likely adopt this coverage policy. This study examined the implementation of SDM in the context of LCS among the privately insured. Methods. We constructed two study cohorts from MarketScan Commercial Claims and Encounters database 2016-2017: a LDCT cohort who received LDCT for LCS and an SDM cohort who had an LCS-related SDM visit. For the LDCT cohort, we examined the trend and factors associated with the receipt of SDM within 3 months prior to LDCT. For the SDM cohort, we studied the trend and factors associated with LDCT within 3 months after an SDM visit. Results. For privately insured adults aged <64, 93% (19,681/21,084) of the LDCT cohort did not have a billing claim indicating SDM, although the uptake of SDM increased from 3.1% in 1Q2016 to 8.2% in 4Q2017 ( P < 0.0001). For the SDM cohort, 46% (948/2048) did not have a claim for an LDCT for lung cancer screening in the 3 months after the SDM visit; this percentage increased from 29.5% in 1Q2016 to 61.8% in 3Q2017 ( P < 0.0001). Limitations. Findings cannot be generalized to other nonelderly adults without private insurance. Additionally, the rate of SDM identified from claims may be underreported. Conclusions. We found a growing but low uptake of SDM among privately insured individuals who underwent LDCT. The higher rate of LDCT in the SDM cohort than the rate reported in national studies emphasized the importance of patient awareness.

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