News | Lung Imaging | March 10, 2021

Experts Recommend Shared Patient - Doctor Decision-making Prior to Lung Cancer Screening

University of North Carolina Lineberger Comprehensive Cancer Center researcher and two other experts endorsed the Center for Medicare & Medicaid Services' (CMS) requirement for a patient and their doctor to engage in a shared discussion of benefits and harms before proceeding with a low-dose spiral computed tomography (LDCT) scan as a method for preventing lung cancer death

Getty Images

March 10, 2021 — In a viewpoint perspective published in JAMA on March 9, 2021, a University of North Carolina Lineberger Comprehensive Cancer Center researcher and two other experts endorsed the Center for Medicare & Medicaid Services' (CMS) requirement for a patient and their doctor to engage in a shared discussion of benefits and harms before proceeding with a low-dose spiral computed tomography (LDCT) scan as a method for preventing lung cancer death. An accompanying evidence report detailed the benefits and harms from screening, suggesting that shared decision-making between a patient and their health care professional is crucial in ensuring screening is used optimally and with fully informed consent.

"In our view, CMS should continue to require, as well as pay for, shared decision-making, including associated tobacco counseling, for people being considered for annual lung cancer screening because having yearly CT screening is a consequential decision," said Daniel Reuland, M.D., MPH, one of the review authors, a member of the UNC Lineberger Comprehensive Cancer Center, and a professor in the division of General Medicine and Clinical Epidemiology at UNC School of Medicine. "Patients should understand the benefits, harms and costs involved, and their values and preferences should be considered. Because the decision-making process can be time-consuming, we also think shared decision-making could be done by trained, non-physician staff."

The experts note that during the COVID-19 pandemic many people have effectively received medical advice through technology such as Skype and Zoom. Therefore, they recommend that CMS continue to pay for counseling delivered by telehealth. In addition, if the patient is a current smoker, they said a professional should counsel that quitting smoking is by far the most important thing the patient can do to stay healthy.

The United States Preventive Services Task Force, the main evaluator of evidence for preventive strategies, now recommends low-dose CT screening for people 50 to 80 years old with a 20 pack-year smoking history. The new recommendations expand the group of people eligible for screening from the initial recommendations in 2013, and includes more Black people, which research has shown have a higher risk of developing lung cancer at earlier ages and with less tobacco exposure. The viewpoint authors believe shared decision-making is more important than ever as it can promote patient engagement, tobacco cessation and screening adherence, which in turn may lead to greater health equity.

As part of standard practice, Reuland, who is also a research fellow at UNC's Cecil G. Sheps Center for Health Services Research, believes that a physician should explicitly ask about the patient's informed values and preferences regarding key tradeoffs of screening and use that information to reach a decision that makes sense for the patient. He also advocates for the use of decision aids, which are tools that can be used to help inform patients by making the essential issues clear and easy to understand.

Reuland said good, shared decision-making is a process that takes time to establish, regardless of whether it is face-to-face or via telehealth. Studies and improvement efforts are underway to learn how to optimize shared decision-making. Indeed, Reuland and others at UNC have recently tested a video decision-making tool and found it increases understanding of the balance between risks and benefits in patients eligible for screening.

"It is important to note that shared decision-making is advisable for all patients considering initiation of annual lung cancer screening, based on ethical grounds, regardless of whether or not they have Medicare or Medicaid. To my knowledge, non-CMS third-party payers will reimburse for this counseling," Reuland said.

For more information: unclineberger.org/

Related lung screening content:

Low-dose CT for Lung Cancer Screening: Benefit Outweighs Potential Harm

AI Analysis Can Improve Lung Cancer Detection on Chest Radiographs

Related Content

IBA (Ion Beam Applications S.A., EURONEXT), a world leader in particle accelerator technology, and SCK CEN (Belgian Nuclear Research Center) announced a strategic R&D partnership to enable the production of Actinimum-225 (225Ac), a novel radioisotope which has significant potential in the treatment of cancer.
News | Radiation Oncology | September 17, 2021
September 17, 2021 — IBA (Ion Beam Applications S.A., EURONEXT), a world leader in particle accelerator technology, a
Shimadzu Medical Systems USA, a leading manufacturer of advanced medical X-ray imaging systems, has announced that the Trinias unity edition product line has been awarded a contract from Vizient, Inc., a healthcare performance improvement company, effective Sept. 1, 2021.
News | X-Ray | September 17, 2021
September 17, 2021 — Shimadzu Medical Systems USA, a leading manufacturer of advanced medical...
Avoiding contrast dyes for imaging tests not necessary if concerned about iodine allergy, peer-reviewed study concludes #MRI

Getty Images

News | Contrast Media Injectors | September 16, 2021
September 16, 2021 — FDB (First Databank), a leading provider of drug and medical device knowledge that helps healthc
This is an example of 3-D ultrasound imaging on a breast, designed to help increase efficiency and diagnostic accuracy in any practice. Image courtesy of Hologic.

This is an example of TriVu ultrasound imaging on a breast, designed to help increase efficiency and diagnostic accuracy in any practice. Image courtesy of Hologic.

Feature | Breast Imaging | September 15, 2021 | By Jennifer Meade
The...
Revised guidelines for lung cancer screening eligibility are perpetuating disparities for racial/ethnic minorities, according to a new study in Radiology.

Getty Images

News | Lung Imaging | September 15, 2021
September 15, 2021 — Revised guidelines for...
To get more flexibility and cost savings from storage, healthcare organizations are increasing their investments in the cloud
Feature | Information Technology | September 15, 2021 | By Kumar Goswami
Healthcare organizations today are storing petabytes of medical imaging data — lab slides,...
Revenues for teleradiology reading service providers are forecast to follow a similar profile over this period.

Outlook for 2021 and Beyond. As displayed in the figure below, these six market drivers are projected to result in teleradiology reading service volumes increasing by 21% in 2021 and nearly doubling by 2025. Revenues for teleradiology reading service providers are forecast to follow a similar profile over this period.

Feature | Teleradiology | September 15, 2021 | By Arun Gill
The closely tied relationship between...