Implementation of Shared Decision Making for Lung Cancer Screening Among the Privately Insured Nonelderly

Introduction. The Centers for Medicare & Medicaid Services requires a written order of shared decision making (SDM) visit in its coverage policy for low-dose computed tomography (LDCT) for lung cancer screening (LCS). With screening eligibility starting at age 55, private insurance plans will likely adopt this coverage policy. This study examined the implementation of SDM in the context of LCS among the privately insured. Methods. We constructed two study cohorts from MarketScan Commercial Claims and Encounters database 2016-2017: a LDCT cohort who received LDCT for LCS and an SDM cohort who had an LCS-related SDM visit. For the LDCT cohort, we examined the trend and factors associated with the receipt of SDM within 3 months prior to LDCT. For the SDM cohort, we studied the trend and factors associated with LDCT within 3 months after an SDM visit. Results. For privately insured adults aged <64, 93% (19,681/21,084) of the LDCT cohort did not have a billing claim indicating SDM, although the uptake of SDM increased from 3.1% in 1Q2016 to 8.2% in 4Q2017 (P < 0.0001). For the SDM cohort, 46% (948/2048) did not have a claim for an LDCT for lung cancer screening in the 3 months after the SDM visit; this percentage increased from 29.5% in 1Q2016 to 61.8% in 3Q2017 (P < 0.0001). Limitations. Findings cannot be generalized to other nonelderly adults without private insurance. Additionally, the rate of SDM identified from claims may be underreported. Conclusions. We found a growing but low uptake of SDM among privately insured individuals who underwent LDCT. The higher rate of LDCT in the SDM cohort than the rate reported in national studies emphasized the importance of patient awareness.