CHEST Guidelines-Shared-Decision-making-and-Lung-Cancer-Screening

Shared-Decision-making-and-Lung-Cancer-Screening_2

Pdf Summary

The article by Nichole T. Tanner, MD, and Gerard A. Silvestri, MD, discusses the role and importance of shared decision-making (SDM) in lung cancer screening (LCS). Screening with low-dose CT has been recommended for those at risk due to age and smoking history to reduce mortality. However, decisions about LCS are complex due to the close balance between risks and benefits, necessitating SDM to ensure that decisions align with patient values and preferences.<br /><br />Centers for Medicare and Medicaid Services require an SDM visit for LCS coverage, highlighting the significant role of patient-centered discussions in healthcare. The article notes that LCS is less about increasing test uptake and more about aligning decisions with patients' informed preferences.<br /><br />Challenges exist in the application of SDM, such as clinician misunderstanding and patient resistance, with evidence suggesting that discussions often emphasize benefits over potential harms. Decision aids have emerged as tools to facilitate SDM by providing balanced information to patients, enhancing their knowledge, and aligning choices with their values.<br /><br />Studies show that both in-person and telephonic SDM consultations can be effective, providing high satisfaction and little decision regret among patients. Novel approaches, including using telehealth for SDM, could improve screening uptake and accessibility, especially in underserved areas.<br /><br />The article suggests that proper education for both patients and clinicians and the potential use of decision counselors could improve implementation. Ultimately, promoting SDM in LCS offers opportunities for discussing broader aspects of health, such as tobacco cessation, thereby significantly impacting patient outcomes. The authors emphasize the continued evolution of SDM as a crucial part of the doctor-patient relationship and patient-centered care.

Keywords

shared decision-making

lung cancer screening

low-dose CT

patient-centered care

decision aids

telehealth

tobacco cessation

Medicare coverage

patient outcomes

healthcare discussions