Abstract:
Lung cancer is the leading cause of cancer death among both men and women, not only in the U.S., but worldwide. For decades, lung cancer was the sole cancer among the top four deadliest cancers without an evidence-based screening method for decreasing mortality. This changed November 2011, when the National Lung Screening Trial (NLST) results showed annual low-dose CT screening was more efficacious in reducing deaths in high-risk persons than radiography. An ever-increasing number of societies and organizations now endorse LDCT for the early detection of lung cancer. More recently, the United States Preventive Services Task Force (USPSTF) and Centers for Medicare and Medicaid Services (CMS) endorsed LDCT screening in eligible persons. Most third party payers have adopted this same stance. Under CMS guidelines, healthcare providers must counsel and document mutual participation between themselves and prospective screenees in a shared decision-making (SDM) visit prior to ordering a screen. During the visit, providers must assess screenee eligibility, document current and or past cigarette use, and discuss benefits and potential harms of LDCT screening including: false positive and over-diagnosis rates and radiation dose exposure. This information must be documented in the screenee’s medical record. Due to the rapid evolution of lung screening CT, many providers and radiologists alike are uncertain of the current eligibility criteria. Likewise, many are not comfortably equipped to discuss the benefits and potential harms associated with screening, which often translates into inconsistent or inaccurate conveyance of critical information. We present our simplified approach to discussing the key elements of SDM with potential screenees as used in our patient-centric lungscreening clinic. A model we hope other centers may find useful and adopt.
