Structured pre-screening counseling and shared decision-making visits with healthcare professionals help patients assess the benefits and risks of yearly lung cancer screening, according to a new study published in CHEST.
Lung cancer screening with low-dose computed tomography (CT) scans offer clear benefits for patients and can save lives. However, radiation exposure has risks and not all patients should be screened.
The study, “Impact of a Lung Cancer Screening Counseling and Shared Decision-Making Visit,” shows that most patients can’t fully understand the benefits or potential dangers of a screening program without informed help.
Doctors recommend screening for people ages 55 and older who have smoked for more than 30 pack-years or the equivalent. Pack-years are calculated by multiplying the number of years an individual has smoked by the number of packs smoked per day.
The benefits of annual lung cancer screening for such people outweigh the risks, current evidence suggests, but there should be a balance — and rules do not apply for everyone equally.
“Screening presents a unique challenge to this balance, as a minority of patients screened will experience the benefit while all have the potential to be harmed,” the study’s lead investigator, Peter J. Mazzone, MD, MPH, said in a press release. “All patients are presumably healthy at the time of screening. In addition, the fulcrum of this balance shifts based on how an individual patient values each side of the balance.”
The program designed for the study included counseling and shared decision-making visits for patients before starting screening. The visits were divided into distinct educational components. Some focused on eligibility requirements, others on the benefits and dangers of yearly screening, as well as the personalized benefit and risk for each candidate.
Based on surveys taken during the sessions, researchers found that patients did not understand much about the eligibility criteria, or the pros and cons of screening before entering the program. But those same screening candidates had a much better grasp on the complexities of screening after studying the new educational material and participating in the shared decision-making process.
In addition, researchers said, patients generally understood the benefits of CT scans more than the risks or the eligibility criteria. Authors hypothesize that this is because health practitioners may feel more comfortable talking about the benefits of a procedure than discussing the complex dangers that may be associated with it.
Patients with little education were also less likely to understand these concepts, but showed improved results during counseling sessions. In fact, Medicare and Medicaid both require such counseling sessions and shared decision-making visits before getting lung cancer screening, but their impact had never been fully investigated.
“This is the first study to show that this visit can improve a patient’s understanding of lung cancer screening, allowing them to make a decision about participation that fits their values,” said Mazzone, director of the Cleveland Clinic’s lung cancer screening program in Cleveland, Ohio.
The study also found that knowledge gained during the visit often fades over time, and suggested that a visit prior to each annual screening may not be a bad idea.
“This would also provide an opportunity to reconfirm eligibility, deliver additional smoking cessation counseling when needed, and build a stronger patient-provider relationship,” Mazzone added. “Information about personalized risk has been shown to help patients make more informed choices about participation in screening for other cancers.”
