Lung Cancer's Social Identity: Historical Insights to Improve Collaborative Decision-Making for Surgery

The role of thoracic surgeons in treating lung cancer has evolved significantly over the past century. Once viewed as authoritative technical experts, today they navigate far more complex clinical and social terrain. As the specialty amassed viable technological interventions, thoracic surgeons have continued as master technicians and medical experts but are also coordinators of interdisciplinary teams and multimodal treatment. Lung cancer's particular social identity, moreover, suggests that surgeons who coordinate lung cancer surgery must also become expert facilitators of shared decision-making (SDM). Using historical research methods, this study explores how lung cancer's clinical realities and social identity emerged as uniquely complex compared with other cancers, and how this complexity makes exceptionally difficult demands on surgeons and patients when they engage in collaborative decision-making. Factors such as the emergence of multiple diagnosis-to-surgery pathways and the stigmatization of smoking and lung cancer contributed to more complex decision-making dynamics for lung cancer surgery. Based on these historical insights, surgeons are encouraged to view SDM not merely as a gesture of respect for patient autonomy, but also as an essential part of clinical practice that integrates cognitive and emotional communication work with patients-patients who bring lung cancer's complicated social identity with them (whether they realize it or not) into decision-making discussions. Greater understanding of how these conversations became so clinically and socially complex, and judicious consideration of how patients are influenced by lung cancer's socio-cultural contexts, can help surgeons facilitate SDM more effectively and ethically.