Screening for Lung Cancer: Communicating With Patients

Impact on patient attitudes towards lung cancer screening and smoking cessation with radiology consultation: Pilot survey project

PURPOSE

We developed a novel patient-radiologist consultation for patients scheduled for lung cancer screening (LCS). We hypothesized that this intervention would improve patient attitudes towards LCS adherence and smoking cessation.

METHODS

This quality improvement project enrolled 38 LCS patients (a majority were African American) and included 20 current and 18 former smokers. The intervention, a 5-10 min consultation with a radiologist who provided preliminary interpretation of pertinent imaging findings in conjunction with smoking cessation counseling, took place in the radiology reading room immediately after the low dose computed tomography (LDCT) patient scan. Pre- and post-intervention surveys assessed patient attitudes towards LCS and smoking cessation.

RESULTS

All recruited patients consented to participate in this project. Regarding viewing their LCS imaging, 86.8% (33/38) expressed general interest initially, with 100.0% (38/38) being more interested afterwards. On LCS logistics, 71.1% (27/38) reported prior knowledge at baseline, while 89.5% (34/38) reported being more informed following the intervention. Among current smokers, 90.0% (18/20) were already motivated towards quitting smoking at baseline, with 100.0% (20/20) exiting the intervention being more interested in doing so. Regarding smoking cessation resources, 95.0% (19/20) were interested in accessing such resources at baseline, and 90.0% (18/20, 2 were same/neutral) were more interested afterwards.

CONCLUSIONS

Patients' attitudes towards LCS and self-reported interest in quitting smoking were directionally higher after the consultation than at baseline. Incorporating LCS consultations with radiologists as part of patient-centered care provides a resource to educate patients on their own LCS imaging findings while promoting LCS adherence and smoking cessation.

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.