CHEST Guidelines-COUNTERPOINT--Can-Shared-Decision-Making-of-Physic

COUNTERPOINT--Can-Shared-Decision-Making-of-Physic

Pdf Summary

In his commentary, Dr. Christopher G. Slatore questions the effectiveness of mandatory shared decision-making (SDM) in improving outcomes for lung cancer screening. Although he supports patient-centered communication, he argues that the formalized process dictated by organizations like CMS may not effectively enhance patient outcomes. Dr. Slatore points out that current SDM practices tend to focus predominantly on information exchange rather than encompassing other critical aspects such as trust and thorough consideration of patient values and preferences. <br /><br />He draws attention to the limitations of existing evidence supporting the benefits of SDM, such as small improvements in patient knowledge but equivocal results on other significant outcomes like quality of life. Moreover, Dr. Slatore highlights the operational challenges, including the impracticality of dedicating extensive portions of clinical visits to SDM when multiple patient priorities need addressing.<br /><br />Despite general support for SDM among patients and clinicians, Dr. Slatore asserts that the mandated, information-focused approach might introduce barriers that could slow the uptake of lung cancer screening. He points out that while decision aids might modestly improve knowledge and reduce decisional conflict, the evidence shows procedural hurdles in implementing these aids effectively.<br /><br />Dr. Slatore underscores that no randomized controlled trials have unequivocally demonstrated the benefits of SDM in lung cancer screening, suggesting the need for further research to establish its effectiveness conclusively. In summary, he advocates reconsidering the CMS requirements until more substantial evidence is available to justify the cost of the formalized SDM approach, which may currently hinder more than it helps in the context of lung cancer screening.

Keywords

shared decision-making

lung cancer screening

patient-centered communication

CMS requirements

patient outcomes

decision aids

clinical visits

randomized controlled trials

patient values

healthcare barriers