1 Health Services Research and Development, and.
2 Division of General Internal Medicine.
Ann Am Thorac Soc. 2017 Oct;14(10):1581-1590. doi: 10.1513/AnnalsATS.201705-378SD.
Screening for lung cancer using low-dose computed tomography has been demonstrated to reduce lung cancer-related mortality and is being widely implemented. Further research in this area is needed to assess the impact of screening on patient-centered outcomes. Here, we describe the design and rationale for a new study entitled Lung Cancer Screening Implementation: Evaluation of Patient-Centered Care. The protocol is composed of an interconnected series of studies evaluating patients and clinicians who are engaged in lung cancer screening in real-world settings. The primary goal of this study is to evaluate communication processes that are being used in routine care and to identify best practices that can be readily scaled up for implementation in multiple settings. We hypothesize that higher overall quality of patient-clinician communication processes will be associated with lower levels of distress and decisional conflict as patients decide whether or not to participate in lung cancer screening. This work is a critical step toward identifying modifiable mechanisms that are associated with high quality of care for the millions of patients who will consider lung cancer screening. Given the enormous potential benefits and burdens of lung cancer screening on patients, clinicians, and the healthcare system, it is important to identify and then scale up quality communication practices that positively influence patient-centered care.
使用低剂量计算机断层扫描进行肺癌筛查已被证明可以降低与肺癌相关的死亡率，并且正在广泛实施。需要在这一领域进行进一步的研究，以评估筛查对以患者为中心的结果的影响。在这里，我们描述了一项名为“肺癌筛查实施：评估以患者为中心的护理”的新研究的设计和原理。该方案由一系列相互关联的研究组成，评估在真实环境中参与肺癌筛查的患者和临床医生。这项研究的主要目标是评估在常规护理中使用的沟通流程，并确定可以在多个环境中推广的最佳实践。我们假设，在患者决定是否参与肺癌筛查时，整体上更高质量的医患沟通流程将与更低水平的困扰和决策冲突相关。这项工作是朝着确定与数百万考虑进行肺癌筛查的患者的高质量护理相关的可改变机制迈出的关键一步。鉴于肺癌筛查对患者、临床医生和医疗保健系统带来的巨大潜在益处和负担，确定并推广积极影响以患者为中心的护理的高质量沟通实践非常重要。
