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Impact of a Lung Cancer Screening Counseling and Shared Decision-Making Visit

Published:February 03, 2017DOI:https://doi.org/10.1016/j.chest.2016.10.027

      Background

      Lung cancer screening is a complex balance of benefits and harms. A counseling and shared decision-making visit has been mandated to assist patients with the decision about participation in screening. To our knowledge, the impact of this visit on patient understanding and decisions has not been studied.

      Methods

      We developed a centralized counseling and shared decision-making visit for our lung cancer screening program. The visit included confirmation of eligibility for screening, education supported by a narrated slide show, individualized risk assessment with a decision aid, time for answering questions, and data collection. We surveyed consecutive patients prior to the visit, immediately after the visit, and 1 month after the visit to determine the impact of the visit on their knowledge.

      Results

      Twenty-three of 423 patients (5.4%) who had a visit did not proceed to the screening CT scan. One hundred twenty-five consecutive patients completed the initial survey, 122 completed the postvisit survey, and 113 completed the 1-month follow-up survey. Prior to the visit, the patients had a poor level of understanding about the age and smoking eligibility criteria (8.8% and 13.6% correct, respectively) and the benefits and harms of screening (55.2% and 38.4% correct, respectively). There was a significant improvement in knowledge noted after the visit for all questions (P = .03 to P < .0001). Knowledge waned by the 1-month follow-up but remained higher than it was before the visit.

      Conclusions

      A centralized counseling and shared decision-making visit impacts the patient's knowledge about the eligibility criteria, benefits, and harms of lung cancer screening with LDCT, helping patients make value-based decisions.

      Key Words

      Abbreviations:

      EMR (electronic medical record), LDCT (low-dose CT)
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