The Center for Health Equity Research and Promotion (CHERP) at the Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia, PA, USA.
Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Med Decis Making. 2021 Apr;41(3):317-328. doi: 10.1177/0272989X20987221. Epub 2021 Feb 6.
A shared decision-making (SDM) process for lung cancer screening (LCS) includes a discussion between clinicians and patients about benefits and potential harms. Expert-driven taxonomies consider mortality reduction a benefit and consider false-positives, incidental findings, overdiagnosis, overtreatment, radiation exposure, and direct and indirect costs of LCS as potential harms.
To explore whether patients conceptualize the attributes of LCS differently from expert-driven taxonomies.
Cross-sectional study with semistructured interviews and a card-sort activity.
Twenty-three Veterans receiving primary care at a Veterans Affairs Medical Center, 55 to 73 y of age with 30 or more pack-years of smoking. Sixty-one percent were non-Hispanic African American or Black, 35% were non-Hispanic White, 4% were Hispanic, and 9% were female.
Semistructured interviews with thematic coding.
The proportion of participants categorizing each attribute as a benefit or harm and emergent themes that informed this categorization.
In addition to categorizing reduced lung cancer deaths as a benefit (22/23), most also categorized the following as benefits: routine annual screening (8/9), significant incidental findings (20/23), follow-up in a nodule clinic (20/23), and invasive procedures (16/23). Four attributes were classified by most participants as a harm: false-positive (13/22), overdiagnosis (13/23), overtreatment (6/9), and radiation exposure (20/22). Themes regarding the evaluation of LCS outcomes were 1) the value of knowledge about body and health, 2) anticipated positive and negative emotions, 3) lack of clarity in terminology, 4) underlying beliefs about cancer, and 5) risk assessment and tolerance for uncertainty.
Anticipating discordance between patient- and expert-driven taxonomies of the benefits and harms of LCS can inform the development and interpretation of value elicitation and SDM discussions.
肺癌筛查（LCS）的共享决策（SDM）过程包括临床医生和患者之间关于益处和潜在危害的讨论。专家驱动的分类法认为降低死亡率是一种益处，并认为假阳性、偶然发现、过度诊断、过度治疗、辐射暴露以及 LCS 的直接和间接成本是潜在的危害。
探讨患者对 LCS 属性的看法是否与专家驱动的分类法不同。
横断面研究，采用半结构化访谈和卡片分类活动。
23 名在退伍军人事务医疗中心接受初级保健的退伍军人，年龄在 55 至 73 岁之间，吸烟 30 年或以上。61%是非西班牙裔非裔美国人或黑人，35%是非西班牙裔白人，4%是西班牙裔，9%是女性。
半结构化访谈和主题编码。
参与者将每个属性归类为益处或危害的比例，以及为这种归类提供信息的新兴主题。
除了将肺癌死亡人数减少归类为益处（22/23）外，大多数人还将以下内容归类为益处：常规年度筛查（8/9）、显著偶然发现（20/23）、结节诊所随访（20/23）和侵入性程序（16/23）。大多数参与者将四个属性归类为危害：假阳性（13/22）、过度诊断（13/23）、过度治疗（6/9）和辐射暴露（20/22）。关于 LCS 结果评估的主题包括 1）关于身体和健康知识的价值，2）预期的积极和消极情绪，3）术语缺乏清晰度，4）对癌症的潜在信念，以及 5）风险评估和对不确定性的容忍度。
预期患者与专家对 LCS 益处和危害的分类之间存在差异，可以为价值评估和 SDM 讨论的制定和解释提供信息。
