Lung cancer screening is a complex balance of benefit and harms. A counseling and shared decision making visit has been mandated to assist patient’s with the decision about participation in screening. The impact of this visit on patient understanding and decisions has not been studied.
We developed a centralized counseling and shared decision making visit for our lung cancer screening program. The visit included confirmation of eligibility for screening, education supported by a narrated slide show, individualized risk assessment with a decision-aid, time for answering questions and data collection. We surveyed consecutive patients prior to their visit, immediately after their visit, and 1-month after their visit to determine the impact of the visit on their knowledge.
23 of 423 (5.4%) patients who had a visit did not proceed on to the screening CT scan. 125 consecutive patients completed the initial survey, 122 the post-visit survey, and 113 the 1-month follow-up survey. Prior to the visit the patients had a poor level of understanding about the age and smoking eligibility criteria (8.8% and 13.6% correct respectively), and the benefit and harms of screening (55.2% and 38.4% correct respectively). There was a significant improvement in knowledge noted after the visit for all questions (p=0.03 – p<0.0001). Knowledge waned by the 1-month follow-up but remained higher than it was pre-visit.
A centralized counseling and shared decision making visit impacts knowledge of the eligibility criteria, benefit, and harms of lung cancer screening with LDCT, helping patients make value based decisions.