CHEST Guidelines-Decisions,-Decisions

Decisions,-Decisions_chest

Pdf Summary

The editorial explores the complexity involved in the shared decision-making (SDM) tools used for lung cancer screening (LCS), particularly highlighting the challenges they present that can hinder its uptake. The Centers for Medicare & Medicaid Services mandate SDM with a decision aid for LCS reimbursement, unlike other screenings, which complicates the process. The existing decision aids, while beneficial, can be cumbersome for use during brief primary care visits, often leading to inadequate or subpar use.<br /><br />Murphy et al.'s study on a decision aid adapted for people with HIV emphasizes the effectiveness of tailoring these tools to meet the specific needs of high-risk groups. Their decision aid includes personalized 5-year risk estimates for lung cancer and mortality and can present this data with or without detailed numerical information, addressing different patient preferences. Participants in this study demonstrated improved knowledge and low decisional conflict, with a high acceptance rate for LCS participation following the decision aid's use.<br /><br />Despite its potential, the editorial acknowledges limitations in the study such as a non-diverse participant pool and the absence of a comparator arm, which diminishes generalizability and a fuller understanding of the tool's impact compared to ordinary care practices.<br /><br />The commentary stresses the need for simplifying decision aids without compromising crucial information needed for informed decision-making, ensuring ease of integration into clinical workflows. Additionally, it calls for increasing inclusivity and diversity in future studies to enhance representational accuracy.<br /><br />Ultimately, the editorial underscores the necessity for streamlined, effective decision aids to potentially boost the LCS completion rates and contribute to more equitable and widespread adoption, particularly among high-risk populations, including those with coexisting conditions like HIV.

Keywords

shared decision-making

lung cancer screening

decision aids

Medicare reimbursement

primary care

HIV

risk estimates

patient preferences

inclusivity

clinical workflows