1 Division of General Internal Medicine.
2 Center for Health Equity Research and Promotion.
Ann Am Thorac Soc. 2016 Nov;13(11):1969-1976. doi: 10.1513/AnnalsATS.201604-290OC.
Radiographic lung cancer screening guidelines and coverage requirements warrant a shared decision-making process. Guidance is needed regarding how to conduct shared decision making effectively. A useful organizing theme should include consideration of a patient's response to and tolerance of uncertainty associated with lung cancer screening.
The objectives of this study are to: (1) describe how patients respond to specific categories of uncertainty in the context of lung cancer screening, and (2) inform strategies for addressing concerns about uncertainty as part of the shared decision making.
We performed two series of structured interviews on participants in a convenience sample of current or former cigarette smokers recruited from primary care and pulmonary practices in Philadelphia. An interview guide included prompts related to benefits, harms, and responses to general and specific types of uncertainty (stochastic, statistical, and evidentiary) associated with lung cancer screening. Interviews were audio-recorded, transcribed, and independently coded by two investigators. An inductive analysis was conducted, and major themes were identified.
Twenty-two adults participated in the study. Sixty-eight percent were men, 72% were black or African American, and 50% met U.S. Preventive Services Task Force criteria for lung cancer screening. The primary themes to emerge from our study were: (1) the desire to decrease uncertainty may motivate lung cancer screening decisions; (2) uncertainty is an attribute of health states that impacts how patients weigh benefits and harms of lung cancer screening; (3) patient understanding and tolerance of uncertainty varies across stochastic, statistical, and evidentiary uncertainty; and (4) provider-patient communication may mitigate intolerance of uncertainty in the context of lung cancer screening.
A systematic approach to understanding and addressing patients' concerns about uncertainty in the context of lung cancer screening can guide a patient-centered approach to shared decision making. The results of this study can inform provider-patient communication strategies regarding the decision to perform radiographic lung cancer screening.
放射学肺癌筛查指南和覆盖要求需要一个共同决策过程。需要指导如何有效地进行共同决策。一个有用的组织主题应该包括考虑患者对与肺癌筛查相关的不确定性的反应和耐受性。
本研究的目的是：（1）描述患者在肺癌筛查背景下对特定类别的不确定性的反应；（2）为解决对不确定性的担忧提供策略，作为共同决策的一部分。
我们对从费城初级保健和肺科诊所招募的当前或以前吸烟者的便利样本中的参与者进行了两个系列的结构化访谈。访谈指南包括与肺癌筛查相关的益处、危害以及对一般和特定类型的不确定性（随机、统计和证据）的反应的提示。访谈进行了录音、转录，并由两名研究人员独立进行编码。进行了归纳分析，并确定了主要主题。
22 名成年人参与了这项研究。68%是男性，72%是黑人和非洲裔美国人，50%符合美国预防服务工作组的肺癌筛查标准。我们的研究中出现的主要主题是：（1）降低不确定性的愿望可能会促使患者做出肺癌筛查决策；（2）不确定性是健康状况的一个属性，影响患者权衡肺癌筛查的益处和危害；（3）患者对不确定性的理解和容忍度因随机、统计和证据不确定性而异；（4）医患沟通可能会减轻肺癌筛查背景下对不确定性的不耐受。
系统地了解和解决患者在肺癌筛查背景下对不确定性的担忧，可以指导以患者为中心的共同决策方法。本研究的结果可以为有关进行放射学肺癌筛查的决策提供医患沟通策略。
