Association of Shared Decision-Making With Long-Term Adherence to Lung Cancer Screening.

Area of Science:

• Pulmonary Medicine
• Health Services Research
• Preventive Cardiology

Background:

• Lung cancer screening (LCS) using low-dose computed tomography (LDCT) reduces mortality but faces low adherence among eligible Medicare beneficiaries.
• Medicare mandates a shared decision making (SDM) visit before initial LCS, aiming to improve adherence, though its long-term impact is unclear.

Purpose of the Study:

• To determine if a SDM visit prior to initial LCS is associated with improved screening adherence in Medicare beneficiaries over time.
• To evaluate the persistent effect of SDM visits on annual LCS adherence.

Main Methods:

• Retrospective cohort study utilizing Medicare fee-for-service claims data from 2016-2019.
• Comparison of beneficiaries with a SDM visit within 90 days before initial LCS versus those without.
• Linear probability models used to estimate differences in annual screening rates for 1-4 years post-initial screening, controlling for covariates.

Main Results:

• 11.4% of 22,670 screened beneficiaries had a preceding SDM visit.
• The SDM group exhibited a 26.5% higher adherence rate in the first year post-LCS compared to the non-SDM group.
• This adherence advantage persisted and increased to 32.5% higher over four years.

Conclusions:

• Shared decision making visits are associated with significantly higher lung cancer screening adherence for up to four years.
• SDM visits represent a viable strategy to enhance LCS adherence rates in the Medicare population.