From conversation to completion: identifying conversation elements to support effective shared decision-making for...

Shared decision-making (SDM) is required for lung cancer screening (LCS) and is intended to support informed, patient-centered decisions. However, SDM implementation in primary care remains inconsistent, particularly in rural settings where LCS uptake is low. This study examined which conversation elements within clinical interactions are associated with LCS completion and may support SDM discussions.

We conducted a cross-sectional survey with screening-eligible adults residing in rural Appalachian communities. Survey items were adapted from the DECISIONS instrument to assess conversation elements within LCS-related clinical interactions, information sources, content discussed, decision attributes, and post-conversation perceptions. Associations between conversation elements and LCS completion were examined using chi-square tests, t-tests, and multivariable logistic regression. Socioeconomic factors were explored to contextualize findings in a rural population with documented health disparities.

Provider initiation of the LCS conversation and provision of educational materials were the two conversation elements independently associated with screening completion. Additional conversation elements, including elicitation of patient preferences and clear provider recommendations, were associated with screening completion in bivariate analyses. Use of educational materials and decision support aids was strongly associated with patients' perceptions of being informed and confident, which were in turn associated with LCS decisions. Socioeconomic indicators were associated with variation in several conversation elements relevant to SDM.

Findings highlight that discrete conversation elements that reflect SDM interactions are differentially associated with behavioral and perceptual outcomes, with provider initiation and educational materials linked to screening completion and decision support and clear recommendations linked to feeling informed and confident. Identifying and prioritizing a small set of key conversation elements that support SDM interactions may inform LCS delivery in rural primary care.