Bade Brett, Gwin Mary, Triplette Matthew, Wiener Renda Soylemez, Crothers Kristina
Veterans Affairs (VA) Connecticut Healthcare System, Section of Pulmonary, Critical Care, and Sleep Medicine, West Haven, CT, United States of America (USA); Yale University School of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, New Haven, CT, USA.
University of Washington School of Medicine, Seattle, WA, USA.
Semin Oncol. 2022 Jun;49(3-4):220-231. doi: 10.1053/j.seminoncol.2022.07.003. Epub 2022 Jul 21.
Shared decision making (SDM) is an important part of lung cancer screening (LCS) that includes discussing the risks and benefits of screening, potential outcomes, patient eligibility and willingness to participate, tobacco cessation, and tailoring a strategy to an individual patient. More than other cancer screening tests, eligibility for LCS is nuanced, incorporating the patient's age as well as tobacco use history and overall health status. Since comorbidities and multimorbidity (ie, 2 or more comorbidities) impact the risks and benefits of LCS, these topics are a fundamental part of decision-making. However, there is currently little evidence available to guide clinicians in addressing comorbidities and an individual's "appropriateness" for LCS during SDM visits. Therefore, this literature review investigates the impact of comorbidities and multimorbidity among patients undergoing LCS. Based on available evidence and guideline recommendations, we identify comorbidities that should be considered during SDM conversations and review best practices for navigating SDM conversations in the context of LCS. Three conditions are highlighted since they concomitantly portend higher risk of developing lung cancer, potentially increase risk of screening-related evaluation and treatment complications and can be associated with limited life expectancy: chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, and human immunodeficiency virus infection.
共同决策（SDM）是肺癌筛查（LCS）的重要组成部分，包括讨论筛查的风险与益处、潜在结果、患者的资格及参与意愿、戒烟，以及为个体患者制定策略。与其他癌症筛查测试相比，LCS的资格认定更为细致入微，纳入了患者的年龄、吸烟史以及整体健康状况。由于合并症和多重合并症（即两种或更多种合并症）会影响LCS的风险与益处，这些话题是决策过程的基本组成部分。然而，目前几乎没有证据可指导临床医生在共同决策问诊期间处理合并症以及个体进行LCS的“适宜性”问题。因此，这篇文献综述调查了接受LCS患者中合并症和多重合并症的影响。基于现有证据和指南建议，我们确定了在共同决策对话中应考虑的合并症，并回顾了在LCS背景下进行共同决策对话的最佳实践。三种情况被重点强调，因为它们同时预示着患肺癌的风险更高，可能会增加筛查相关评估和治疗并发症的风险，并且可能与预期寿命有限相关：慢性阻塞性肺疾病、特发性肺纤维化和人类免疫缺陷病毒感染。
