Implementing Decision Coaching for Lung Cancer Screening in the Low-Dose Computed Tomography Setting.

Abstract

The uptake of shared decision making (SDM) for lung cancer screening (LCS) as required by the Centers for Medicare & Medicaid Services (CMS) is suboptimal. Alternative models for delivering SDM are needed, such as decision coaching in the low-dose computed tomography (LDCT) setting. The Replicating Effective Programs framework guided our implementation of decision coaching, which included a patient-facilitated component before screening followed by in-person coaching that addressed the required elements for the SDM visit from CMS. We surveyed two LCS patient cohorts (pre-implementation and implementation of decision coaching) about their knowledge of LCS and perception of the SDM process. We conducted time-motion studies to assess the feasibility of implementing decision coaching and audio recorded clinical encounters from the implementation cohort to assess fidelity of the SDM conversation to the CMS requirements. Compared with the pre-implementation cohort (n = 51), the implementation cohort (n = 30) had greater knowledge of LCS (P < .01) and reported a better SDM process (P = .01). Coaching took 7.6 ± 4.1 minutes and did not increase visit time (P = .72). Coaches addressed an average of 6.4 of 7 SDM elements required by CMS. Decision coaching in the LDCT setting provides an opportunity for patients to confirm their screening decision by ensuring that patients are truly informed about the potential harms and benefits of LCS. The decision coaching had excellent fidelity in addressing the required SDM elements from CMS and is feasible.