Linking Patient Perceptions of Shared Decision Making to Satisfaction in Lung Cancer Screening Decisions

IntroductionLung cancer is especially prevalent among US veterans, and lung cancer mortality can be reduced through lung cancer screening (LCS). LCS guidelines recommend shared decision making (SDM) to help patients weigh the benefits and harms of LCS and make informed, values-based decisions about screening. Yet some question whether SDM affects patient outcomes. This study evaluated US veterans' perceptions of LCS SDM quality and its relationship with satisfaction in LCS decisions.MethodsWe administered surveys via mail and phone to veterans in the VA New England Healthcare Network after recent LCS conversations. SDM quality was measured using CollaboRATE, with top scores indicating high quality. Decision satisfaction was assessed using the Satisfaction with Decision scale. Generalized linear models analyzed associations between perceived SDM quality and decision satisfaction, adjusting for demographics, health, and overall care satisfaction.ResultsAmong 1,033 patients who received surveys, 320 responded (31.0%), with 220 recalling the LCS conversation. Among those who answered the CollaboRATE questions, 34.0% (73/215) perceived SDM to be high quality ("top scorers"). Perceived high-quality SDM was significantly associated with greater decision satisfaction compared with lower perceived SDM quality (adjusted mean satisfaction on a 30-point scale = 26.75 v. 24.23; P < 0.001). A greater proportion of patients who received, versus did not receive, patient education materials rated SDM as high quality (44.4% v. 27.7%, P = 0.018).LimitationsThe sample was primarily White, male, and all US veterans, limiting generalizability to other LCS-eligible cohorts. The cross-sectional design prevents causal inferences and long-term follow-up.ConclusionsHigher perceived SDM quality was associated with greater patient satisfaction with the LCS decision. Improving SDM processes can enhance patient engagement and may improve LCS adherence and health outcomes.HighlightsHigher perceived shared decision making (SDM) quality in lung cancer screening (LCS) discussions leads to greater patient satisfaction with screening decisions.While the use of patient education materials was linked to higher perceived SDM quality, less than half of patients who received materials rated SDM as high quality. There remains room for improved design and delivery to ensure materials effectively support the SDM process and guidance to providers on how to effectively incorporate patient educational materials to support, rather than replace, high-quality SDM conversations.Enhancing SDM processes and aligning them with patient preferences can support patient satisfaction with their decision, which may have downstream benefits to patient engagement, adherence, and improved outcomes.