Introduction

Shared decision-making is a recommended approach aimed at supporting patients in making informed decisions regarding lung cancer screening. This approach recognizes the importance of involving patients in the decision-making process and considering their values, preferences, and individual circumstances. However, implementing shared decision-making in clinical practice may present challenges. 

The objective of this study was to characterize patients’ perspectives regarding shared decision-making (SDM) and decisional conflict (DC) with respect to lung cancer screening in underserved populations.

Methods

Participants were recruited from a centralized lung cancer screening program in a safety-net system in Houston, Texas, implemented in 2019. A sample of 150 consecutive individuals from a pool of 246 participants who completed an LDCT scan within 12 months of the survey was invited via postal mail from September through December 2021.

We report descriptive data from 62 participants (41% participation). Descriptive statistics and chi-square tests were calculated to characterize differences between SDM and DC.

Results

The sample included equal numbers of males and females, 60% current smokers, 61% with an educational background of high school or less, and 71% with a household income less than $15,000. Good SDM process was reported among 52% of men and 48% of women, 56% of non-smokers and 44% of smokers, 68% of younger patients and 32% of older patients. Some decisional conflict was reported among 55% of females and 46% of males; 68% of smokers and 32% of non-smokers; 68% of minority groups and 32% of non-Hispanic Whites; and 77% of those with household incomes less than $15,000 and 23% of those with household incomes greater than $15,000. None of these differences were statistically significant.

Conclusion

This study provides preliminary estimates of patient perspectives among participants in a lung cancer screening program for underserved populations. About half of the respondents reported problems with both SDM and DC, suggesting the value of ongoing assessment and opportunities for improvement. Results need to be interpreted with caution, however, due to limited power. 

Lung cancer screening recommendations center on the communication process surrounding an individual’s decision to undergo screening with the goal of improving patient-centered outcomes. Further research is needed to better understand challenges in SDM and DC in these and possibly other underserved populations.