Eberth Jan M, Zgodic Anja, Pelland Scott C, Wang Stephanie Y, Miller David P
Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene St., Columbia, SC, 29208, USA.
Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, USA.
J Cancer Educ. 2023 Apr;38(2):522-537. doi: 10.1007/s13187-022-02148-w. Epub 2022 Apr 30.
Shared decision-making (SDM) helps patients weigh risks and benefits of screening approaches. Little is known about SDM visits between patients and healthcare providers in the context of lung cancer screening. This study explored the extent that patients were informed by their provider of the benefits and harms of lung cancer screening and expressed certainty about their screening choice. We conducted a survey with 75 patients from an academic medical center in the Southeastern U.S. Survey items included knowledge of benefits and harms of screening, patients' value elicitation during SDM visits, and decisional certainty. Patient and provider characteristics were collected through electronic medical records or self-report. Descriptive statistics, Kruskal-Wallis tests, and Pearson correlations between screening knowledge, value elicitation, and decisional conflict were calculated. The sample was predominately non-Hispanic White (73.3%) with no more than high school education (53.4%) and referred by their primary care provider for screening (78.7%). Patients reported that providers almost always discussed benefits of screening (81.3%), but infrequently discussed potential harms (44.0%). On average, patients had low knowledge about screening (score = 3.71 out of 8) and benefits/harms. Decisional conflict was low (score = - 3.12) and weakly related to knowledge (R= - 0.25) or value elicitation (R= - 0.27). Black patients experienced higher decisional conflict than White patients (score = - 2.21 vs - 3.44). Despite knowledge scores being generally low, study patients experienced low decisional conflict regarding their decision to undergo lung cancer screening. Additional work is needed to optimize the quality and consistency of information presented to patients considering screening.
共同决策（SDM）有助于患者权衡筛查方法的风险和益处。在肺癌筛查背景下，患者与医疗服务提供者之间的共同决策就诊情况鲜为人知。本研究探讨了医疗服务提供者向患者告知肺癌筛查的益处和危害的程度，以及患者对其筛查选择表达的确定性。我们对美国东南部一家学术医疗中心的75名患者进行了一项调查。调查项目包括对筛查益处和危害的了解、共同决策就诊期间患者的价值观引导以及决策确定性。通过电子病历或自我报告收集患者和医疗服务提供者的特征。计算了描述性统计数据、Kruskal-Wallis检验以及筛查知识、价值观引导和决策冲突之间的Pearson相关性。样本主要为非西班牙裔白人（73.3%），受教育程度不超过高中（53.4%），由其初级保健提供者转诊进行筛查（78.7%）。患者报告称，医疗服务提供者几乎总是讨论筛查的益处（81.3%），但很少讨论潜在危害（44.0%）。平均而言，患者对筛查及其益处/危害的了解程度较低。决策冲突较低（得分=-3.12），与知识（R=-0.25）或价值观引导（R=-0.27）的相关性较弱。黑人患者的决策冲突高于白人患者（得分=-2.21对-3.44）。尽管知识得分普遍较低，但研究中的患者在决定接受肺癌筛查方面的决策冲突较低。需要开展更多工作来优化向考虑进行筛查的患者提供的信息的质量和一致性。
