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Patient-physician discussions on lung cancer screenings are inadequate

by John R. Fischer, Senior Reporter | August 21, 2018
CT X-Ray

The trial also identified the potential harms of screening, such as false positives, which lead to invasive follow-up procedures that do not find any cancer, wasting both physician and patient time and saddling patients with unnecessary costs. More than 95 percent of lung nodules found on screening CT scans are not cancerous.

Another issue was overdiagnosis, in which screenings lead to the diagnosis of cancers that would not affect a patient during his or her lifetime if left untreated.

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Echoing these sentiments is the U.S. Preventive Services Task Force, which, since 2013, has recommended annual lung cancer screenings with low-dose CT for adults between 55 and 80 who have smoked a minimum of 30 pack-years, as in 20 cigarettes a day annually for 30 years. This advice also applies to those who are still smoking or have only quit in the last 15.

In addition, the USPSTF recommends that decisions to screen follow a "thorough discussion of the possible benefits, limitations and the known and uncertain terms," publishing just this month its final preparation plan for adjusting its research and evaluation protocols for CT lung cancer screening.

Reuland suggests that doing so requires the implementation of better systems and infrastructure to ensure screenings are properly discussed, and investing in more approaches, such as decision aids, to help clinical support staff educate patients.

"Providers should be forthright about the uncertainties inherent in screening and make authentic attempts to help patients understand these. They really should use a decision aid and plan to set aside time for a decision like this with patients. This may mean scheduling a separate visit, at least for the initial decision about initiating annual lung cancer screening," he said. "In addition, all physicians should advocate for a payment model that encourages the provision of patient education and decision support outside of face-to-face visits and incentivizes informed and shared decisions rather than a large volume of brief, face-to-face office visits."

Conversations were derived from a database of 5,300 recorded interactions provided by Verilogue, a private patient-physician dialogue research company. Of the 137 that meet keyword criteria for the study, fourteen specifically addressing lung cancer screenings were chosen.

In addition to Reuland, the study’s first author is Alison Brenner, a UNC Lineberger member and assistant professor at the UNC School of Medicine; Teri Malo of UNC Lineberger; Marjorie Margolis and Shynah James of UNC Gillings; Jennifer Elston Lafata of UNC Lineberger and UNC Eshelman School of Pharmacy; and Maihan B. Vu of UNC Gillings and UNC-Chapel Hill.

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