ASPO Abstracts
Primary Care Physicians' Perspectives on Shared Decision Making about Lung Cancer Screening
Category: Behavioral Science & Health Communication
Conference Year: 2020
Abstract Body:
Purpose: In 2015, the Centers for Medicare and Medicaid Services announced coverage for annual lung cancer
screening (LCS) with low dose computed tomography (LDCT) for patients who satisfy defined eligibility criteria and
go through a shared decision making (SDM) session. This study was intended to gain insights into provider
perceptions about SDM for LCS practices and the use of an online decision aid.
Methods: Between Fall 2018-Fall 2019, we conducted 45-60-minute semi-structured interviews with internal
medicine and family medicine physicians in a large urban medical center. The interviewers sought to elicit
physicians’ views about two categories of interest: 1) SDM in LCS, and 2) use of the Decision Counseling
Program© (DCP). The interviews were audio-recorded and transcribed for analysis. Transcripts were coded using
direct content analysis in NVivo 12, and major themes were identified.
Results: A total of 16 physicians (nine internal medicine and seven family/community medicine) were interviewed
in this pilot study. In terms of perceptions related to SDM in LCS, respondents reported: a) physicians and patients
have limited information about LCS and related guidelines; b) patients rely on physicians to guide them through
decision making about LCS; c) physicians do not use decision aids to support SDM about LCS and believe they
are doing SDM; and d) physicians are receptive to exploring alternative strategies for doing SDM related to LCS.
Regarding use of the DCP, respondents reported: a) physicians believe that a standard process to support SDM is
needed; b) it is important to tailor DCP use to meet patient needs related to language, culture, and health literacy
needs; and c) physicians would benefit from guidance on how to integrate the DCP into the practice workflow.
Conclusions: Findings from this pilot study indicate that SDM about LCS in primary care is limited, but physicians
are receptive to learning how to change this situation. Research is needed to determine how health systems can
facilitate the implementation of increasing SDM about LCS in routine care.
Keywords: Lung cancer screening, decision aids, health communication