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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.
CHEST Pulmonary
|August 4, 2026
Summary
Shared decision-making (SDM) in lung cancer screening (LCS) may boost participation and information quality without increasing regret. Evidence is limited, but patient-facing tools show promise for improving LCS uptake.
Area of Science:
- Public Health and Preventive Medicine
- Health Services Research
- Clinical Decision Making
Background:
- Lung cancer screening (LCS) using low-dose CT is recommended for eligible individuals.
- Centers for Medicare and Medicaid Services mandates counseling and shared decision-making (SDM) for LCS reimbursement.
- The precise effects and optimal strategies for LCS SDM remain poorly understood.
Purpose of the Study:
- To systematically review the effects of shared decision-making (SDM) tools and strategies in lung cancer screening (LCS).
- To evaluate the impact of different SDM approaches on LCS participation and patient outcomes.
- To assess the quality of evidence regarding LCS SDM implementation.
Main Methods:
- Systematic review of US-based randomized controlled trials and observational studies of LCS SDM from January 2010 to December 2023.
- Searches conducted in Embase, MEDLINE, and CINAHL.
- Dual abstraction and risk-of-bias assessment using Cochrane RoB 2.0 and Joanna Briggs Institute tools; certainty of evidence graded using GRADE.
Main Results:
- Thirty-one studies were included, exhibiting significant variability in design and methodology, precluding quantitative analysis.
- Shared decision-making (SDM), particularly when facilitated by care coordinators or patient navigators, may increase lung cancer screening (LCS) participation with acceptable information quality (low certainty of evidence).
- SDM did not increase decisional conflict or regret (high certainty of evidence), and the choice of SDM tool may not significantly affect LCS uptake (low certainty of evidence).
Conclusions:
- Limited evidence exists for LCS SDM due to study variability and short follow-up periods.
- SDM appears to enhance LCS participation and information quality without negatively impacting decisional conflict or regret.
- While specific tool choice may not be critical, decision aids might be superior to educational tools; implementation should consider feasibility and delivery methods.