View Abstract

A5979 - ""I Just Wanna Know"": A Qualitative Study of Patients Offered Lung Cancer Screening
Author Block: S. Golden1, S. Ono1, S. Thakurta1, R. S. Wiener2, A. C. Melzer3, S. Datta4, C. G. Slatore1; 1VA Portland Health Care System, Portland, OR, United States, 2Boston University School of Medicine, Boston, MA, United States, 3Pulmonary and Critical Care, Minneapolis VA Healthcare System, Minneapolis, MN, United States, 4sujata.thakurta@va.gov, Durham, NC, United States.
Rationale: Lung cancer screening (LCS) is now recommended for people at high risk of developing lung cancer. Communication may be one of the few modifiable factors that can lead to improved patient-centered outcomes among patients undergoing LCS.
Methods: Qualitative evaluation of patient experience (n=25) after a LCS decision making visit (mean=32 days) but before the scan, with a focus on: reasons for accepting screening, and communication based on a patient-centered communication (PCC) theoretical model, including information exchange, patient as person, and shared decision making domains. We included patients from three institutions with established LCS programs; two Veteran’s Affairs (VA) and one non-VA. We used conventional content analysis.
Results: Twenty-three participants accepted screening and two did not. We did not find substantially different themes based on where the participant received care. Participants who accepted screening largely reported “just wanting to know” if they had lung cancer, or that LCS seemed like a good idea based on a recommendation from their clinician.
Participants reported the biggest benefit of screening was to catch cancer early if it was found but could not describe the magnitude of benefit. Participants could not recall much information about the risks of LCS despite undergoing a decision-making visit and usually explicit review of a decision aid, but remained satisfied and confident they could obtain more information if needed. Those who reported receiving more information were appreciative and usually indicated more information as better. Many reported, however, that only “the basic information” was necessary.
Only a few felt distressed about the possibility of a lung cancer diagnosis after their decision to undergo LCS. They reported that trust in their clinician or the health care system to follow-up and take care of their health problems prevented distress. None reported their clinician explicitly asked about values and preferences, a core component of shared decision making, but participants were satisfied with their role in the decision-making process, largely due to trust in their clinician.
Conclusions: Patients desired LCS due to curiosity and trust in their clinician, an important aspect of their decision making. Despite recalling little information about LCS and lack of actual shared decision making, patients were very satisfied with LCS communication and their decision. These findings suggest that actual
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shared decision making in this context may not substantially influence patient-centered outcomes, and other domains of communication may be more important for high quality care.