Unpacking the relationship between shared decision-making and decisional quality, decision to screen, and screening completion in lung cancer screening.
Lisa Carter-Bawa, James E Slaven, Patrick O Monahan and 5 others
PMID 38237528WHAT IT FOUND
Most patients who had a shared decision-making talk chose lung cancer screening, and most who chose it completed it.
Feeling clear about the choice, knowing more, and believing the decision was shared tracked with screening.
Key findings
01Of 529 patients, 504 (95.3%) decided to screen after the shared decision-making discussion, and 399 (75.4%) completed screening.
02Among patients who decided to screen, those who completed a lung scan had lower decisional conflict scores (mean 20.21) than those who did not complete one (mean 25.36), indicating higher decisional quality.
03Higher knowledge, higher self-efficacy, and greater perception that the decision was shared were associated with higher decisional quality; higher knowledge and higher self-efficacy were also associated with screening completion.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study included only patients who had a documented shared decision-making visit, and the overall participation rate was 35.2%, so it may not represent patients who did not have such a visit or who did not respond. The sample was insured, 87.5% White, and 34.4% had completed college, so results may not apply to more diverse populations. The setting was an integrated health system with a long-standing lung cancer screening program and clinician and staff education, which may explain the high screening completion rate compared with national estimates below 10-15%. Because the design was observational, it cannot show that better decisional quality, knowledge, self-efficacy, or perceived shared decision-making caused screening.
Declared interests
The supplied publication types list NIH extramural research support. No author conflict-of-interest declaration is included in the supplied article text.
The easy way to misread this
Do not conclude that shared decision-making or higher decisional quality causes patients to complete lung cancer screening. This was an observational study of patients who already had a shared decision-making visit, so it can only report associations.