Improving lung cancer screening starts with the primary care provider: Enhancing shared decision making for optimal patient outcomes.

Abstract

306 Background: Despite the critical importance of lung cancer screening (LCS), its uptake remains dismally low, with only 5.8% of eligible individuals undergoing screening. To harness the potential benefits of LCS, there is an urgent need for shared decision making (SDM) between patients and primary care physicians (PCPs), who often serve as the initial point of contact. Recognizing this need, the Centers for Medicare and Medicaid Services endorse LCS through low-dose computed tomography (LDCT) following SDM. This study aims to enhance SDM and increase LCS utilization by providing PCPs with a comprehensive checklist to address key points and better utilize their time. Methods: A concise checklist was created, which included pertinent points to address during an SDM meeting. This checklist was then given to the PCPs. Fifty-eight (58) PCPs affiliated with two hospitals in the Indiana University Health system agreed to implement the LCS-SDM checklist during office visits with eligible patients. All participating PCPs had existing relationships with LCS-eligible patients, received specific instructions for implementing the LCS-SDM checklist, and agreed to allocate a portion of their visits for SDM. In total, 194 patients on Medicare participated in this study and were interviewed: 158 had no documented history of LCS discussions, while 36 had previously been offered and refused LDCT. Following SDM interviews, PCPs completed written surveys to evaluate the impact of the LCS-SDM checklist on their practice and the perceived effectiveness of SDM. The patients were also surveyed to assess their receptiveness to the SDM process. Results: The majority of the 58 PCPs expressed support for utilizing SDM in LCS; however, time constraints emerged as a significant limiting factor. Despite feeling rushed during the SDM sessions, the PCPs acknowledged the value of the checklist as a helpful reference tool. Among the 158 patients who had not previously discussed LCS, 91 out of 158 patients (57.6%) opted to undergo screening. Among the 36 patients who initially declined LDCT, 20 out of 36 patients (55.5%) chose to participate in LCS after revisiting the topic. Impressively, 192 out of 194 patients (98.9%) expressed appreciation for the opportunity to engage in SDM. Conclusions: The results underscore the significant benefits of SDM in LCS, demonstrating its potential to improve uptake and patient outcomes. While time constraints present challenges for PCPs, both patients and physicians generally respond positively to SDM sessions. By implementing comprehensive checklists and facilitating dedicated time for SDM, primary care providers can effectively enhance LCS utilization and empower patients to make informed decisions regarding their lung health.