CHEST Guidelines-POINT--Can-Shared-Decision-Making-of-Physicians-an

POINT--Can-Shared-Decision-Making-of-Physicians-an

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The article examines the impact of shared decision-making (SDM) between physicians and patients on lung cancer screening (LCS) outcomes. Historically, the medical field has moved away from paternalistic approaches towards SDM, which involves discussing medical options with patients and considering their values and preferences. This approach is key in patient-centered care, empowering patients who must live with the decisions made.<br /><br />Lung cancer screening is a preference-sensitive decision where patients must balance potential benefits, such as reduced mortality, with harms like false positives and radiation exposure. SDM allows patients to make informed choices about LCS by understanding these trade-offs. Evidence from other cancer screening contexts suggests that SDM, often facilitated by decision aids, can improve a variety of patient outcomes, including knowledge and satisfaction, and aligns treatment decisions more closely with patient values.<br /><br />Despite its benefits, implementing SDM in routine practice, especially for LCS, faces challenges. Barriers include limited time, lack of access to decision aids, and insufficient knowledge among primary care providers. The Centers for Medicare & Medicaid Services (CMS) requires SDM for LCS reimbursement and has fostered its adoption, but adherence remains inconsistent.<br /><br />One promising solution is to centralize LCS programs, delegating SDM responsibilities to trained LCS personnel like nurse coordinators, who can conduct SDM with dedicated time and resources. This model has been successful in the Veterans Health Administration and other programs, resulting in better-informed patients who value the interaction. If nationwide changes, like telephone SDM visits, were implemented, access to high-quality SDM for LCS could be improved, which, according to preliminary evidence, may enhance patient adherence to LCS. Overall, high-quality SDM is seen as crucial to optimizing the benefits of LCS for patients.

Keywords

shared decision-making

lung cancer screening

patient-centered care

decision aids

patient outcomes

medical field

preference-sensitive decision

CMS reimbursement

nurse coordinators

Veterans Health Administration