Shared decision-making visits significantly boost CT lung cancer screening adherence
Shared decision-making visits significantly boost patients’ adherence to low-dose CT lung cancer screening, according to new research published Wednesday.
Numerous studies have explored poor uptake of LDCT, with rates as low as 18% among eligible individuals.
Researchers with the American College of Radiology’s Neiman Policy Institute recently explored whether “shared decision-making” visits—required by Medicare as part of CT referrals—can boost screening adherence. They found a clear correlation, with imaging rates nearly 27% higher than those who did not meet with their primary care provider to discuss their risks and benefits of lung cancer screening, according to the study results, published in Chest.
“Shared decision-making is more than just a billing requirement—it’s a valuable opportunity to engage patients in informed, personalized discussions about screening,” study author Farouk Dako, MD, MPH, associate professor of radiology, with the Perelman School of Medicine in Philadelphia, said in a July 9 announcement from the Policy Institute. “There is an opportunity to leverage this new evidence in national campaigns to raise awareness of lung screening and the importance of prioritizing SDM in routine clinical care to improve early detection and outcomes for one of the deadliest forms of cancer."
For the study, Dako and colleagues used a 5% representative sample of fee-for-service Medicare claims data to pinpoint patients who underwent their first LDCT exam sometime between 2016 and 2019. They compared a cohort of 2,573 individuals (11.4%) who visited their doctor for a shared decision-making discussion within 90 days before the baseline imaging exam against another 20,097 patients (88.7%) who did not. On average, patients were part of the retrospective study for about 3.2 years after baseline.
Those who underwent a shared decision-making visit showed a 21% to 33% higher imaging adherence rate in subsequent years compared to the control group. And the difference did not diminish over time, the authors reported, “suggesting a potential long-term positive impact” of these conversations. Adherence one year after the initial low-dose CT scan was about 34.8%, higher than previous studies on this subject, dropping to 23.8% by the fourth year. Shared decision-making rates plateaued at about 12.1% during the study period.
“Our study provides empirical evidence that [shared decision-making] could be an effective tool in improving long-term [lung cancer screening] adherence,” lead author YoonKyung Chung, PhD, principal researcher with the Neiman Policy Institute, and co-authors reported. “Based on our findings, a direct strategy to improve long-term LCS adherence among the Medicare population is to increase the uptake of SDM. Despite the positive effects of the SDM process on LCS implementation shown by existing studies, the uptake of SDM is low.”
While the number of low-dose CTs nearly doubled during the study period, use of these required pre-scan visits was only about 11.4%. This is “puzzling,” the authors noted, given that Medicare has since 2015 required them as part of paying for lung cancer screening. Neiman researchers guessed possible explanations for the discrepancy. Perhaps Medicare has not strictly enforced the mandate as a requirement for screening reimbursement. Or the low reimbursement rate relative to the time required to discuss all necessary elements of screening—such as the benefits and harms of imaging, including false positives and radiation exposure—may be motivating providers to skip them.
“Several studies have identified the time constraint as a barrier to [shared decision-making] implementation,” the authors noted. “Promoting SDM through increased reimbursement commensurate with the time needed to complete all SDM components is feasible way to promote SDM uptake among the intention-to-screen population within the Medicare program. In 2022, CMS relaxed some of the SDM requirements, allowing more flexibility around the visit provider type and the use of decision-aid tools and making a telehealth option for SDM visits permanent. Further research should assess the effectiveness of these changes on SDM uptake.”
Read more about the results, including potential study limitations, in the official journal of the American College of Chest Physicians here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.