Implementing Decision Coaching for Lung Cancer Screening in the Low-Dose Computed Tomography Setting

Area of Science:

• Oncology
• Public Health
• Health Services Research

Background:

• Shared decision-making (SDM) uptake for lung cancer screening (LCS) is suboptimal.
• Alternative models are needed to improve SDM delivery.
• Decision coaching in low-dose computed tomography (LDCT) settings is a potential solution.

Purpose of the Study:

• To implement and evaluate a decision coaching model for LCS.
• To assess the impact of decision coaching on patient knowledge and SDM perception.
• To determine the feasibility and fidelity of decision coaching in meeting Centers for Medicare & Medicaid Services (CMS) requirements.

Main Methods:

• The Replicating Effective Programs framework guided the implementation of decision coaching.
• Two LCS patient cohorts (pre- and post-decision coaching implementation) were surveyed.
• Time-motion studies and audio recordings of clinical encounters assessed feasibility and fidelity.

Main Results:

• The implementation cohort showed greater LCS knowledge (P < .01) and better SDM perception (P = .01) compared to the pre-implementation cohort.
• Decision coaching averaged 7.6 ± 4.1 minutes and did not significantly increase visit time (P = .72).
• Coaches addressed an average of 6.4 out of 7 required SDM elements.

Conclusions:

• Decision coaching in the LDCT setting enhances patient understanding of LCS harms and benefits.
• The decision coaching model demonstrated excellent fidelity to CMS SDM requirements.
• Decision coaching is a feasible and effective intervention for improving SDM in LCS.