Schweiger Liana, Golden Sara E, Sullivan Donald R, Ilea Ian, Rice Sean P M, Melzer Anne C, Datta Santanu, Davis James M, Slatore Christopher G
Division of Pulmonary, Allergy, & Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.
MDM Policy Pract. 2024 Oct 17;9(2):23814683241286884. doi: 10.1177/23814683241286884. eCollection 2024 Jul-Dec.
The Centers for Medicare and Medicaid Services mandate that clinicians use a shared decision-making interaction to provide information about the harms and benefits of lung cancer screening (LCS). We enrolled patients from 3 geographically diverse medical centers after a decision-making interaction about undergoing LCS but before receiving a low-dose computed tomography (CT) scan. We performed the primary analysis based on the primary knowledge question, "Which of these conditions do you think that the CT scan screens for?" We used the knowledge summary score in secondary analyses. We evaluated LCS care experience by using validated instruments to measure participant-reported communication quality (Consultation Care Measure), perception of the primary LCS clinician (Consumer Assessment of Health Care Providers and Systems), and decision conflict (Decisional Conflict Scale). Of the 409 participants, 44% correctly answered the primary LCS knowledge question. Clinician communication quality was rated positively by 93% of participants. Most (93%) participants rated their LCS clinician as good. Only 14% reported decision conflict. Correctly answering the primary LCS knowledge question was associated with higher patient-clinician communication quality scores (b = 0.4; 95% confidence interval [CI] [0.1, 0.7]; change = 0.03) and higher LCS clinician ratings (b = 0.4; 95% CI [0.0, 0.7]; change = 0.02) but not with decision conflict. In secondary analyses, higher total LCS knowledge score was associated with lower Decisional Conflict Scale scores (b = -2.2; 95% CI [-3.4, -0.9]; change = 0.24), indicating lower decision conflict. After an LCS decision-making interaction, many patients do not retain basic knowledge about LCS but nevertheless had low levels of decision conflict. Primary LCS knowledge may be important but insufficient to ensure high-quality, patient-centered LCS care.
Survey of patients with a lung cancer screening (LCS) decision-making interaction.Only 44% of patients correctly answered the knowledge question about LCS.Primary LCS knowledge was not associated with decision conflict.Patient knowledge about LCS may not equate to high-quality patient-centered care.
医疗保险和医疗补助服务中心规定，临床医生应通过共享决策互动来提供有关肺癌筛查（LCS）的危害和益处的信息。我们在3个地理位置不同的医疗中心招募了患者，这些患者在就接受LCS进行决策互动之后，但在接受低剂量计算机断层扫描（CT）之前。我们基于主要知识问题“你认为CT扫描能筛查出以下哪些病症？”进行了主要分析。我们在二次分析中使用了知识总结分数。我们通过使用经过验证的工具来评估LCS护理体验，这些工具用于测量参与者报告的沟通质量（咨询护理测量）、对主要LCS临床医生的看法（医疗服务提供者和系统消费者评估）以及决策冲突（决策冲突量表）。在409名参与者中，44%正确回答了主要的LCS知识问题。93%的参与者对临床医生的沟通质量给予了积极评价。大多数（93%）参与者对他们的LCS临床医生评价良好。只有14%的人报告有决策冲突。正确回答主要的LCS知识问题与更高的医患沟通质量得分（b = 0.4；95%置信区间[CI][0.1, 0.7]；变化 = 0.03）和更高的LCS临床医生评分（b = 0.4；95% CI[0.0, 0.7]；变化 = 0.02）相关，但与决策冲突无关。在二次分析中，更高的LCS总知识得分与更低的决策冲突量表得分相关（b = -2.2；95% CI[-3.4, -0.9]；变化 = 0.24），表明决策冲突较低。在LCS决策互动之后，许多患者没有记住关于LCS的基本知识，但决策冲突水平仍然较低。主要的LCS知识可能很重要，但不足以确保高质量的、以患者为中心的LCS护理。
对进行肺癌筛查（LCS）决策互动的患者进行调查。只有44%的患者正确回答了关于LCS的知识问题。主要的LCS知识与决策冲突无关。患者对LCS的了解可能并不等同于高质量的以患者为中心的护理。
