Shared decision-making in follow-up care for lung cancer screening.

Abstract

12114 Background: Shared decision-making (SDM) is a critical component of lung cancer screening (LCS) decisions to ensure patients understand the benefits, risks, and follow-up processes. Follow-up discussions on adherence to LCS present unique challenges, including managing patient expectations, addressing concerns about outcomes, and integrating smoking cessation efforts. This study uses The Centers for Disease Control and Prevention (CDC) SHARE model to examine SDM dynamics to identify areas for improvement in patient-provider communication. Methods: A thematic content analysis using ATLAS.ti was conducted by four trained coders on transcripts from primary care provider (PCP) visits between September 2022 and May 2024 with 24 patients referred for LCS. Guided by the CDC SHARE model for SDM—Seek, Help, Assess, Reach, and Evaluate—consultations were analyzed to examine how PCP revisited prior screening attempts and results, engaged patients in follow-up screening decisions, and addressed barriers to continued screening and smoking cessation. Inter-rater agreement ranged from 83.8% to 92.3%. Code prevalence was assessed using frequency counts (i.e., groundedness). Results: Five themes from the SHARE model were identified: (1) Evaluating prior LCS decisions made in the past (15), (2) Seeking patient participation in the SDM process by explicitly communicating that a choice about LCS adherence still exists (n = 7); (3) Helping patients explore the risks and benefits of LCS, including clarifying potential risks and outcomes (n = 13); (4) Assessing patient values and concerns regarding LCS, such as fears about false positives or financial burden (n = 8); and (5) Reaching a decision about a new LCS, where PCP guided patients through the decision-making process and confirmed next steps (n = 21). In addition to the themes derived from the SHARE model, two new emergent themes were identified: (a) providing supportive talk and reassurance (n = 7) to address patient uncertainty and encourage engagement in LCS; and (b) addressing smoking cessation if patients indicated that they still smoke (n = 6), with discussions initiated primarily by PCP and narrowly focused on pharmacological treatments. Notably, LCS decision aids were not used or discussed in any consultation. Conclusions: This study identifies strengths and gaps in PCP communication during LCS discussions. While PCP assessed patient risk factors and facilitated screening decisions, significant gaps in SDM emerged. Smoking cessation discussions were limited, and decision aids were absent, highlighting missed opportunities for patient-centered care. Follow-up consultations for LCS require addressing barriers to adherence to LCS and integration of smoking cessation as a standard component of care. Incorporating decision aids could improve patient engagement and adherence to long-term screening recommendations.