LUNG CANCER SCREENING WITHOUT SHARED DECISION-MAKING: A MISSING PART OF AN IMPORTANT SCREENING PROGRAM

Abstract

SESSION TITLE: Advancing the Decision-Making Process in Lung Cancer SESSION TYPE: Original Investigations PRESENTED ON: 10/22/2019 10:45 AM - 11:45 AM PURPOSE: Almost 5 years have passed since the U.S. Preventive Service Task Force (USPSTF) released a guideline for lung cancer screening with low-dose computed tomography (LDCT) (Ref 1). Though it is clearly stated that “The decision to begin screening should be the result of a thorough discussion of the possible benefits, limitations, and known and uncertain harms” (1), it is unclear this is carried out. METHODS: A retrospective cross-sectional study was conducted in a community-based teaching hospital. Patients evaluated at the internal medicine clinic between August-September 2018 with a history of smoking were initially screened using electronic medical record. Inclusion criteria include (1) age: between 55 and 80-year-old (2) active smokers or those who quit in less than 15 years (3) smoked at least 30-pack-year. Patients who are younger than 18 years of age or without a clear documented history of smoking were excluded from the study. Once we have identified the candidates, we have reviewed the progress notes to further review the documentation in relation to lung cancer screening. RESULTS: We have identified 298 patients who visited the clinic during the period. 126 patients had a history of smoking, either active or in the past. Among them, 22 (17.4%) patients were identified to meet the inclusion criteria. LDCT was ordered for 20 (90.9%) patients. 36 patients with smoking history (28.5%) had incomplete documentation about the amount of smoking, with 14 patients being within the age range for LDCT of the chest. Benefits and risks of the screening were properly discussed and documented in the electronic medical record in 9 patients (45%). Six studies (30%) were not completed despite the medical orders. CONCLUSIONS: Our study implies further interventions are needed to improve the quality of documentation for smoking and lung cancer screening. The areas need particular improvement are the documentation of shared decision making as well as the documentation of the accurate smoking history. CLINICAL IMPLICATIONS: Since the USPSTF released the recommendation for lung cancer screening (Ref 1), many patients benefited from the screening tool and mortality benefits has been proven among high-risk patients (Ref 2). Though it is clearly stated the need for the discussion of possible benefit and risk, our study suggests that there is room for improvement in the practice or documentation. Our study also suggests there often exists the lack of detailed documentation for smoking, including the number of cigarettes smoking, a crucial part to determine eligibility for lung cancer screening. DISCLOSURES: No relevant relationships by Aristides Armas Villalba, source=Web Response No relevant relationships by Taro Minami, source=Web Response