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Veterans' Lung Cancer Risk Conceptualizations versus Lung Cancer Screening Shared Decision-Making Conversations with

Jacqueline H Boudreau1,2, Rendelle E Bolton1,2, Eduardo R Núñez1,2,3,4

  • 1Center for Healthcare Optimization & Implementation Research, VA Boston Healthcare System, Boston, MA, USA.

Medical Decision Making : an International Journal of the Society for Medical Decision Making
|November 22, 2024
PubMed
Summary

Veterans perceive lung cancer risk from multiple factors, including airborne hazards, but clinicians focus mainly on smoking during screening discussions. This disconnect may hinder effective shared decision-making for lung cancer screening (LCS).

Keywords:
cancer risklung cancer screeningshared decision makingsmoking cessationveterans

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Area of Science:

  • Pulmonary Medicine
  • Oncology
  • Health Services Research

Background:

  • The Veterans Health Administration (VA) recommends lung cancer screening (LCS) with shared decision-making.
  • Understanding veteran perceptions of lung cancer risk and their discussions with clinicians is crucial.

Purpose of the Study:

  • To characterize veteran conceptualizations of lung cancer risk.
  • To examine veteran and clinician accounts of shared decision-making discussions about LCS.
  • To assess if LCS discussions reflect veteran concerns.

Main Methods:

  • Qualitative interviews with 48 clinicians and 34 veterans at 6 VA sites.
  • Thematic analysis of transcripts focusing on risk perceptions and decision-making conversations.

Main Results:

  • Veterans' risk perceptions included smoking, occupational hazards, and family history.
  • Clinicians primarily focused on smoking as the main risk factor.
  • LCS conversations centered on smoking, often neglecting other significant veteran-identified risks.

Conclusions:

  • Clinicians' focus on smoking during LCS discussions overlooks other significant risk factors perceived by veterans, such as airborne hazards.
  • This discrepancy may lead to less engaging and potentially stigmatizing shared decision-making processes.