The Radiologist as Direct Public Educator: Impact of Sessions Demystifying Select Cancer Screening Imaging Examinations

Prospective Multisite Cohort Study to Evaluate Shared Decision Making Utilization Among Individuals Screened for Lung Cancer

PURPOSE

The aim of this study was to determine the frequency, components of, and factors associated with shared decision-making (SDM) discussions according to electronic health record (EHR) documentation among individuals undergoing lung cancer screening (LCS).

METHODS

A prospective observational cohort study was conducted of individuals undergoing LCS between February 2015 and June 2020 at four LCS centers. The primary outcome was EHR-documented SDM, defined using Medicare-designated components. A multivariable logistic regression model was used to examine predictors of EHR-documented SDM. A secondary outcome was agreement of individual's self-report of SDM and EHR-documented SDM, evaluated using Cohen's κ statistic.

RESULTS

Among screened individuals, 41.9% (243 of 580) had EHR-documented SDM, and 71.1% (295 of 415) had self-reported SDM. Decision aids were used in 55.6% of EHR-documented SDM encounters (135 of 243), and 21.8% of documented SDM encounters (53 of 243) included all Medicare-designated components. SDM was documented more frequently in individuals with body mass index ≥ 25 versus <25 kg/m² (adjusted odds ratio [aOR], 1.63; 95% confidence interval [CI], 1.05-2.52) and in currently versus formerly smoking individuals (aOR, 1.53; 95% CI, 1.02-2.32). Nonpulmonary referring clinicians were less likely to document SDM than pulmonary clinicians (internal medicine: aOR, 0.32; 95% CI, 0.18-0.53; family medicine: aOR, 0.08; 95% CI, 0.04-0.14; other specialties: aOR, 0.08; 95% CI, 0.03-0.21). In a subset of 415 individuals, there was little agreement between individual self-report of SDM and EHR-documented SDM (κ = 0.184), with variation in agreement on the basis of referring clinician specialty.

CONCLUSIONS

Although EHR-documented SDM occurred in fewer than half of individuals undergoing LCS, self-reported SDM rates were higher, suggesting that SDM may be underdocumented in the EHR. In addition, EHR-documented SDM was more likely in individuals with higher body mass index and those referred for LCS by pulmonary clinicians. These findings indicate areas for improvement in the implementation and documentation of SDM.

The radiologist's role in lung cancer screening

Lung cancer is still the deadliest cancer in men and women worldwide. This high mortality is related to diagnosis in advanced stages, when curative treatment is no longer an option. Large randomized controlled trials have shown that lung cancer screening (LCS) with low-dose computed tomography (CT) can detect lung cancers at earlier stages and reduce lung cancer-specific mortality. The recent publication of the significant reduction of cancer-related mortality by 26% in the Dutch-Belgian NELSON LCS trial has increased the likelihood that implementation of LCS in Europe will move forward. Radiologists are important stakeholders in numerous aspects of the LCS pathway. Their role goes beyond nodule detection and nodule management. Being part of a multidisciplinary team, radiologists are key players in numerous aspects of implementation of a high quality LCS program. In this non-systematic review we discuss the multifaceted role of radiologists in LCS.

Using Social Media as a Platform for Increasing Knowledge of Lung Cancer Screening in High-Risk Patients

Background

Uptake in lung cancer screening for high-risk patients remains low. Eligible patients may not know that this preventive service is available and covered by insurance.

Objectives

The objective of this study was to explore using social media to educate patients about lung cancer screening and assess motivation to discuss lung cancer screening with health-care providers after viewing the educational program.

Methods

Subjects ages 55 to 77 who were current smokers or former smokers who quit in the past 15 years with a more than 30-pack-year smoking history were recruited via a Facebook advertisement. Subjects completed a demographic survey and the Lung Cancer Screening-12 (LCS-12) knowledge measure tool, watched a YouTube video about lung cancer screening, and completed the LCS-12 tool (post-test). Subjects rated their level of motivation to discuss lung cancer screening with their health-care provider.

Results

This study used a pre-experimental, one-group pre-test and post-test design. Scores from the pre- and post-test were analyzed using the paired t-test. Descriptive statistics were used to analyze subject self-reporting of motivation to discuss screening with their provider. The mean knowledge score of participants (n = 31) significantly increased from 5.26 to 8.19 after viewing the video (t = -5.956, p < .001). The mean motivational level (1-5) was 3.52, with a mode of 5.

Conclusions

A lack of knowledge regarding lung cancer screening may negatively impact the health of high-risk patients. This study suggests that social media can be used to increase knowledge of lung cancer screening. These findings demonstrate that the use of social media has a role in improving access to health information.

Leveraging Facebook to Brand Radiology

In the current health care climate, radiologists should consider developing their brand. Facebook is the market leader for social media networking in the United States. The authors describe how radiologists can leverage Facebook to develop and market organizational, group, and individual brands. The authors then address concerns related to the use of social media by radiologists.