Unpacking the relationship between shared decision-making and decisional quality, decision to screen, and screening completion in lung cancer screening.

Carter-Bawa L, Slaven JE, Monahan PO, Brandzel S, Gao H, Wernli KJ, Lafata JE, Rawl SM. Unpacking the relationship between shared decision-making and decisional quality, decision to screen, and screening completion in lung cancer screening. Patient education and counseling. 2024 Jan 11; 122:108143.

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Abstract:

OBJECTIVES: Lung cancer screening is a complex and individualized decision. To understand how best to support patients in this decision, we must understand how shared decision-making is associated with both decisional and behavioral outcomes. METHODS: Observational cohort study combining patient survey data with electronic health record data of lung screening-eligible patients who recently engaged in a shared decision-making discussion about screening with a primary care clinician. RESULTS: Using multivariable analysis (n  =  529), factors associated with higher lung cancer screening decisional quality include higher knowledge (OR  =  1.33, p  <  .0001), lower perceived benefits (OR  =  0.90, p  =  .0004), higher perceived barriers (OR  =  1.07, p  <  .0001), higher self-efficacy (OR  =  1.13, p  <  .0001), and higher levels of perceiving the discussion was shared (OR  =  1.04, p  <  .0001). Factors associated with the patient's decision to screen include older age (OR  =  1.12, p  =  .0050) and higher self-efficacy (OR  =  1.11, p  =  .0407). Factors associated with screening completion included older age (OR  =  1.05, p  =  .0050), higher knowledge (OR  =  1.24, p  =  .0045), and higher self-efficacy (OR  =  1.12, p  =  .0003). CONCLUSIONS: Shared decision-making in lung cancer screening is a dyadic process between patient and clinician. As we continue to strive for high-quality patient-centered care, patient decision quality may be enhanced by targeting key factors such as high-quality knowledge, self-efficacy, and fostering a shared discussion to support patient engagement in lung cancer screening decisions.