CHEST Guidelines-Rebuttal-From-Dr-Slatore

Rebuttal-From-Dr-Slatore_chest

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Dr. Christopher G. Slatore responds to Dr. Wiener’s arguments about the role of shared decision-making (SDM) in improving outcomes for lung cancer screening. While he agrees with Wiener that SDM has potential to enhance outcomes, Slatore emphasizes the gap between potential outcomes ("can") and actual outcomes ("does"), citing limitations in current research. He highlights that although existing studies provide a foundation for further research, they are insufficient to justify mandatory formal approaches to SDM, as required by the Centers for Medicare & Medicaid Services.<br /><br />Slatore argues that SDM should enhance patient knowledge about the benefits and risks of screening. However, many patients might not prioritize this knowledge highly. He notes that in related research, patients ranked knowledge about lung cancer screening benefits and risks low, and the mere act of sharing the decision did not necessarily lead to better patient-centered outcomes. Instead, role concordance (alignment between a patient’s preferred and actual decision-making role) was linked to higher perceived care quality.<br /><br />He contends that focusing solely on information exchange in SDM is short-sighted, advocating for a more nuanced approach that considers patient values and preferences. Slatore calls for evidence from randomized trials to validate the effectiveness of formalized SDM approaches. He underscores that while SDM principles are worthwhile for lung cancer screening, implementing them requires substantial evidence of benefit, paralleling the adage about the difference between wishes and actionable outcomes.<br /><br />Overall, Slatore stresses that SDM should be tailored to individual patients, enhancing communication and accommodating their specific needs and preferences, rather than adhering to rigid, checklist-driven methodologies.

Keywords

shared decision-making

SDM

lung cancer screening

patient knowledge

role concordance

patient-centered outcomes

randomized trials

patient values

formalized approaches

communication