Is Lung Cancer Screening Knowledge Associated with Patient-Centered Outcomes? A Multi-institutional Cohort Study

Introduction. The Centers for Medicare and Medicaid Services mandate that clinicians use a shared decision-making interaction to provide information about the harms and benefits of lung cancer screening (LCS). Methods. We enrolled patients from 3 geographically diverse medical centers after a decision-making interaction about undergoing LCS but before receiving a low-dose computed tomography (CT) scan. We performed the primary analysis based on the primary knowledge question, “Which of these conditions do you think that the CT scan screens for?” We used the knowledge summary score in secondary analyses. We evaluated LCS care experience by using validated instruments to measure participant-reported communication quality (Consultation Care Measure), perception of the primary LCS clinician (Consumer Assessment of Health Care Providers and Systems), and decision conflict (Decisional Conflict Scale). Results. Of the 409 participants, 44% correctly answered the primary LCS knowledge question. Clinician communication quality was rated positively by 93% of participants. Most (93%) participants rated their LCS clinician as good. Only 14% reported decision conflict. Correctly answering the primary LCS knowledge question was associated with higher patient-clinician communication quality scores (b = 0.4; 95% confidence interval [CI] [0.1, 0.7]; R² change = 0.03) and higher LCS clinician ratings (b = 0.4; 95% CI [0.0, 0.7]; R² change = 0.02) but not with decision conflict. In secondary analyses, higher total LCS knowledge score was associated with lower Decisional Conflict Scale scores (b = −2.2; 95% CI [−3.4, −0.9]; R² change = 0.24), indicating lower decision conflict. Conclusions. After an LCS decision-making interaction, many patients do not retain basic knowledge about LCS but nevertheless had low levels of decision conflict. Primary LCS knowledge may be important but insufficient to ensure high-quality, patient-centered LCS care. Survey of patients with a lung cancer screening (LCS) decision-making interaction. Only 44% of patients correctly answered the knowledge question about LCS. Primary LCS knowledge was not associated with decision conflict. Patient knowledge about LCS may not equate to high-quality patient-centered care.

Duke Scholars

Author James Davis Medicine, General Internal Medicine