Patient and Clinician Perspectives on Shared Decision-making in Early Adopting Lung Cancer Screening Programs: a Qualitative Study.

Autor: Wiener RS; Center for Healthcare Organization & Implementation Research, ENRM VA Hospital, Bedford, MA, USA. renda.wiener@va.gov.; The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA. renda.wiener@va.gov., Koppelman E; Center for Healthcare Organization & Implementation Research, ENRM VA Hospital, Bedford, MA, USA.; Boston University School of Public Health, Boston, MA, USA., Bolton R; Center for Healthcare Organization & Implementation Research, ENRM VA Hospital, Bedford, MA, USA.; The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA., Lasser KE; Boston University School of Public Health, Boston, MA, USA.; Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA., Borrelli B; Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA., Au DH; Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA.; Division of Pulmonary Critical Care Medicine, University of Washington, Seattle, WA, USA., Slatore CG; Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.; Division of Pulmonary & Critical Care Medicine, Oregon Health & Science University, Portland, OR, USA., Clark JA; Center for Healthcare Organization & Implementation Research, ENRM VA Hospital, Bedford, MA, USA.; Boston University School of Public Health, Boston, MA, USA., Kathuria H; The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.
Jazyk: angličtina
Zdroj: Journal of general internal medicine [J Gen Intern Med] 2018 Jul; Vol. 33 (7), pp. 1035-1042. Date of Electronic Publication: 2018 Feb 21.
DOI: 10.1007/s11606-018-4350-9
Abstrakt: Background: Guidelines recommend, and Medicare requires, shared decision-making between patients and clinicians before referring individuals at high risk of lung cancer for chest CT screening. However, little is known about the extent to which shared decision-making about lung cancer screening is achieved in real-world settings.
Objective: To characterize patient and clinician impressions of early experiences with communication and decision-making about lung cancer screening and perceived barriers to achieving shared decision-making.
Design: Qualitative study entailing semi-structured interviews and focus groups.
Participants: We enrolled 36 clinicians who refer patients for lung cancer screening and 49 patients who had undergone lung cancer screening in the prior year. Participants were recruited from lung cancer screening programs at four hospitals (three Veterans Health Administration, one urban safety net).
Approach: Using content analysis, we analyzed transcripts to characterize communication and decision-making about lung cancer screening. Our analysis focused on the recommended components of shared decision-making (information sharing, deliberation, and decision aid use) and barriers to achieving shared decision-making.
Key Results: Clinicians varied in the information shared with patients, and did not consistently incorporate decision aids. Clinicians believed they explained the rationale and gave some (often purposely limited) information about the trade-offs of lung cancer screening. By contrast, some patients reported receiving little information about screening or its trade-offs and did not realize the CT was intended as a screening test for lung cancer. Clinicians and patients alike did not perceive that significant deliberation typically occurred. Clinicians perceived insufficient time, competing priorities, difficulty accessing decision aids, limited patient comprehension, and anticipated patient emotions as barriers to realizing shared decision-making.
Conclusions: Due to multiple perceived barriers, patient-clinician conversations about lung cancer screening may fall short of guideline-recommended shared decision-making supported by a decision aid. Consequently, patients may be left uncertain about lung cancer screening's rationale, trade-offs, and process.
Databáze: MEDLINE
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