Experts recommend patient-doctor decisions before lung cancer screening

CHAPEL HILL, NC – In view of a scene published in JAMA on March 9, 2021, a University of North Carolina Center for Comprehensive Cancer Center researcher Lineberger and two other experts backed the Medicare & Medicaid Services Center (CMS) requirement for a patient and their physician to engage in a shared discussion about previous benefits and injuries go ahead with a low-dose computed tomography (LDCT) computed tomography scan as a way to prevent lung cancer death. An accompanying evidence report detailed the benefits and harms of screening, suggesting that shared decisions between a patient and their healthcare professional are essential to ensure that screening is used appropriately and effectively. with full informed consent.

“In our view, CMS should continue to seek, in addition to paying for, shared decisions, including related tobacco counseling, for people who are considered for annual lung cancer screening because CT screening is an ongoing decision every year, “said Daniel Reuland, MD, MPH, one of the review authors, a member of the UNC Lineberger Comprehensive Cancer Center, and professor in the department of General Medicine and Clinical Epidemiology at the 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 believe that shared decisions could be made by trained, non-physician staff. . ”

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

The U.S. Consecration Services Action Group, the lead evidence assessor for prevention strategies, is now recommending low-dose CT screening for people 50 to 80 years with a 20-year packaged smoking history. The new proposals broaden the group of people eligible for screening from the first recommendations in 2013, and include more black people, whose research has shown that they have a higher risk of developing lung cancer. develop at an earlier age and with less tobacco. The authors of the show believe that shared decision-making is more important than ever because it can promote patient participation, tobacco cessation and continued screening, which in turn can lead to greater health. .

As part of routine practice, Reuland, who is also a researcher at the UNC’s Cecil G. Sheps Center for Health Services Research, believes that a physician should clearly ask about the patient’s informed values ​​and preferences regarding key trade-offs. screening and use that information to make a decision that makes sense to the patient. It also advocates for the use of supportive devices, which are tools that can be used to inform patients by making the necessary issues clear and easy to understand.

Reuland said good, shared decisions are a process that takes time to establish, whether it’s face-to-face or through telehealth. Studies and development efforts are underway to learn how to best make shared decisions. In fact, Reuland and others at UNC have recently tested a video decision-making tool and found that it increases understanding of the balance between risks and benefits in patients eligible for screening.

“It is important to note that shared decisions are recommended for all patients considering starting annual lung cancer screening, based on ethical reasons, whether Medicare or Medicaid. To my knowledge, non – CMS third party. payers will get a refund for this consultation, “Reuland said.

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In addition to Reuland, other authors of the paper are Richard M. Hoffman, MD, MPH, University of Iowa Carver College of Medicine, and Robert J. Volk, PhD, University of Texas MD Anderson Cancer Center.

Reuland has received grants from the National Cancer Institute; he is also a member of the National Lung Cancer Shared Decision Making (NLCRT) working group. Hoffman is a member of the NLCRT Shared Decision Making working group. Volk has received grants from NCI and the Texas Institute for Cancer Prevention and Research when the study was conducted; he is a member of the NLCRT Shared Decision Making Action Group and has been reimbursed for travel expenses to the NLCRT annual meeting.