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

CDC and FDA Call for Pause on Janssen COVID-19 Vaccine Due to Rare Blood Clots #COVID19 #Janssen
Feature | Coronavirus (COVID-19) | April 15, 2021 | By Dave Fornell
April 15, 2021 — The U.S.
#SiemensHealthineers #Varian #Siemens The transformative combination accelerates the company’s impact on #global #healthcare and establishes a strong partner for #customers and #patients along the entire #cancer care continuum and for many of the most threatening #diseases
News | Radiology Business | April 15, 2021
April 15, 2021 — Siemens Healthineers AG an
Comparisons of high definition and standard definition infrared imaging for digital histopathology. Image courtesy of the Beckman Institute

Comparisons of high definition and standard definition infrared imaging for digital histopathology. Image courtesy of the Beckman Institute

News | Breast Imaging | April 14, 2021
April 14, 2021 — Detecting and analyzing breast cancer
A doctor reading #CXR scans using #SenseCare-Chest #DR Pro #diagnostic #software.

A doctor reading CXR scans using SenseCare-Chest DR Pro diagnostic software.

News | Artificial Intelligence | April 14, 2021
April 14, 2021 — SenseTime, a world-leading...
The U.S. Food and Drug Administration (#FDA) authorized marketing of #Medtronic's #GIGenius, the first device that uses #artificialintelligence (#AI) based on #machinelearning to assist #clinicians in detecting #lesions (such as #polyps or suspected tumors) in the #colon in real time during a c#olonoscopy.

The GI Genius intelligent endoscopy module works in real-time, automatically identifying and marking (with a green box) abnormalities consistent with colorectal polyps, including small flat polyps.

News | Artificial Intelligence | April 12, 2021
A 37-year-old woman developed a new, palpable left supraclavicular lymphadenopathy lump five days after her first dose of the Moderna COVID-19 vaccine in the left arm. On the day of vaccination, the patient was asymptomatic. This is an example of how the vaccine can mimic cancer and swollen lymph nodes. Image used with permission of RSNA.

A 37-year-old woman developed a new, palpable left supraclavicular lymphadenopathy lump five days after her first dose of the Moderna COVID-19 vaccine in the left arm. On the day of vaccination, the patient was asymptomatic. This is an example of how the vaccine can mimic cancer and swollen lymph nodes. Read more about this case study. Image used with permission of RSNA.

Feature | Coronavirus (COVID-19) | April 09, 2021 | By Dave Fornell, Editor
While the mass COVID-19 vaccinat
3-D mammography reduces the number of breast cancer cases diagnosed in the period between routine screenings, when compared with traditional mammography, according to a large study from Lund University in Sweden. The results are published in the journal Radiology.

Getty Images

News | Breast Imaging | April 09, 2021
April 9, 2021 — 3-D mammography reduces the number of breast cancer cases diagnosed in the period between routine scr
IV contrast-enhanced 2-mSv 4-mm-thick transverse and coronal (b) CT images show inflamed diverticula (arrows), segmental colonic wall thickening, and adjacent pericolic fat stranding. Image courtesy of the American Roentgen Ray Society (ARRS), American Journal of Roentgenology (AJR)

IV contrast-enhanced 2-mSv 4-mm-thick transverse and coronal (b) CT images show inflamed diverticula (arrows), segmental colonic wall thickening, and adjacent pericolic fat stranding. Image courtesy of the American Roentgen Ray Society (ARRS), American Journal of Roentgenology (AJR)

News | Computed Tomography (CT) | April 09, 2021
April 9, 2021 — According to an open-acc...