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Shared Decision-Making for Lung Cancer Screening: A Systematic Review
Adrienne Landsteiner1, Nicholas Zerzan1, Kristen E Ullman1
1Center for Care Delivery & Outcomes Research, VA Health Care System, Minneapolis, MN.
Background:
Lung cancer screening (LCS) with annual low-dose CT scanning is recommended for eligible individuals. The Centers of Medicare and Medicaid Services stipulates that counseling and shared decision-making (SDM) are a prerequisite for LCS reimbursement; however, SDM effects and optimal strategies are poorly understood.
Research Question:
What are the effects of LCS SDM tools and strategies?
Study Design And Methods:
This was a systematic review of US-based randomized controlled trials or observational studies of LCS SDM with a comparator. We searched Embase and MEDLINE via Ovid and CINAHL via EbscoHost for dates January 2010 through December 2023. We used dual abstraction and risk-of-bias (RoB) assessment with Cochrane RoB 2.0 tool for randomized controlled trials and Joanna Briggs Institute RoB for observational studies. Certainty of evidence (CoE) was based on Grading of Recommendations, Assessment, Development, and Evaluation.
Results:
Thirty-one studies were eligible. Studies varied in design, intervention, comparator, and methodology precluding quantitative analysis. Few reports provided adequate information to assess if they met Centers of Medicare and Medicaid Services SDM criteria. We summarized findings by whether the tool was a health care provider- or patient-facing tool or material. Few studies addressed uptake, adherence, and harms. SDM, including by care coordinators or patient navigators, may increase LCS participation with acceptable information quality (low CoE) and does not increase decisional conflict/regret (high CoE). The choice of SDM tool may not affect LCS uptake (low CoE). Little evidence exists on whether effects vary by patient or clinic characteristics.
Interpretation:
LCS SDM evidence is limited due to study variability and short follow-up. SDM may increase LCS participation, has acceptable information quality, and does not increase decisional conflict/regret. Most studies reported on knowledge; few addressed clinical and patient-centered outcomes. Specific SDM tool choice may not impact LCS. A decision aid may be superior to an education tool. Implementation should consider feasibility and that delivery included print, web, in-person, and video, with most patient-facing.
Clinical Trial Registration:
International Prospective Register of Systematic Reviews; No.: CRD42024511257; URL: https://www.crd.york.ac.uk/prospero/.