ASPO Abstracts
Implementation of Shared Decision Making for Lung Cancer Screening
Category: Behavioral Science & Health Communication
Conference Year: 2020
Abstract Body:
Purpose. The Centers for Medicare and Medicaid Services has stipulated shared decision making (SDM) as a prerequisite to lung cancer screening (LCS) reimbursement. Given SDM has proven challenging to implement in practice, it remains unclear how organizations have approached its implementation for LCS. We describe how health care organizations implemented SDM for LCS, including factors considered as these programs were developed and implemented, and the challenges faced.
Methods. We used in-depth, semi-structured interviews with key informants (N=30) directly involved with implementing and/or managing SDM for LCS in 23 organizations representing 12 states and the 4 US Census regions. Key informants were identified via snowball sampling. We used template analysis to identify key constructs from the Consolidated Framework for Implementation Research that organizations considered when implementing LCS-SDM programs.
Results. Resultant programs were centralized models in which frontend practitioners (e.g., primary care providers) referred patients to a LCS clinic in which trained staff (e.g. advanced practice nurses) delivered SDM at the time of screening or decentralized models in which frontend practitioners delivered SDM prior to referring patients for screening. Some organizations used both models. Participants discussed tradeoffs between SDM quality and access, as they perceived centralized models as enhancing SDM quality, but limiting patient LCS-SDM access and vice versa. Regardless of model implemented, participants reported ongoing challenges with limited resources and budgetary constraints, ambiguity regarding what constitutes SDM, and an absence of benchmarks for evaluating LCS-SDM quality.
Conclusions. Those responsible for developing and managing SDM-LCS programs voice concerns regarding both patient access and SDM quality, regardless of organizational context or LCS-SDM model. The challenge facing these organizations, and thus those wanting to help patients and clinicians balance the tradeoffs inherent with LCS, is how to move beyond a “check box” documentation requirement to a process that enables LCS to be offered to all high risk patients, but used only by those who are informed and for whom screening represents a value concordant service.
Keywords: Lung cancer screening shared decision making