1. Challenges Addressing Lung Cancer Screening for Patients With Multimorbidity in Primary Care: A Qualitative Study
- Author
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Kale, Minal S., Morgan, Orly, Wisnivesky, Juan, Schnur, Julie, and Diefenbach, Michael A.
- Subjects
United States. Centers for Medicare and Medicaid Services ,Oncology, Experimental -- Health aspects ,Medicine, Preventive -- Health aspects ,Cancer patients -- Health aspects ,Cancer -- Diagnosis -- Research ,Comorbidity -- Health aspects ,Lung cancer -- Health aspects ,Preventive health services -- Health aspects ,Health ,Science and technology - Abstract
PURPOSE Many individuals who are eligible for lung cancer screening have comorbid conditions complicating their shared decision-making conversations with physicians. The goal of our study was to better understand how primary care physicians (PCPs) factor comorbidities into their evaluation of the risks and benefits of lung cancer screening and into their shared decision-making conversations with patients. METHODS We conducted semistructured interviews by videoconference with 15 PCPs to assess the extent of shared decision-making practices and explore their understanding of the intersection of comorbidities and lung cancer screening, and how that understanding informed their clinical approach to this population. RESULTS We identified 3 themes. The first theme was whether to discuss or not to discuss lung cancer screening. PCPs described taking additional steps for individuals with complex comorbidities to decide whether to initiate this discussion and used subjective clinical judgment to decide whether the conversation would be productive and beneficial. PCPs made mental assessments that factored in the patient's health, life expectancy, quality of life, and access to support systems. The second theme was that shared decision making is not a simple discussion. When PCPs did initiate discussions about lung cancer screening, although some believed they could provide objective information, others struggled with personal biases. The third theme was that ultimately, the decision to be screened was up to the patient. Patients had the final say, even if their decision was discordant with the PCP's advice. CONCLUSIONS Shared decision-making conversations about lung cancer screening differed substantially from the standard for patients with complex comorbidities. Future research should include efforts to characterize the risks and benefits of LCS in patients with comorbidities to inform guidelines and clinical application. Key words: lung cancer screening; preventive medicine; comorbidities; multimorbidity; clinical reasoning; judgment; paternalism; beneficence; personal autonomy; risk-benefit assessment; life expectancy; quality of life; counseling; education of patients; shared decision making; patient-centered care; holistic health; primary care; practice-based research, INTRODUCTION The United States Preventive Services Task Force (USPSTF) guidelines recommend lung cancer screening (LCS), with an annual low dose-computed tomography scan of the chest, for individuals who meet age [...]
- Published
- 2024
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