Patients who sat down with a radiologist to discuss low-dose CT lung cancer screening more often chose to follow through with the exam than those who met with another type of clinician, according to new research.
In fact, Medicare enrollees who participated in a shared-decision making (SDM) visit with an imaging expert were nine times more likely to undergo low-dose computed tomography screening.
At the same time, University of Texas Medical Branch at Galveston authors found lower LDCT screening rates following SDM visits between patients and doctors who were familiar with one another
“The decision to undergo LDCT lung cancer screening varies substantially by the clinician participating in the SDM,” the authors wrote Monday in JAMA Network Open. “Ideally in SDM, one might expect that all the variation in choice of LDCT would be because of differences between individual enrollees in perceived risk of cancer, willingness to undergo surgery if recommended, and personal values.”
James S. Goodwin, MD, and Shuang Li, PhD, both with the university’s Department of Internal Medicine, suggested some clinicians who were unknown to patients may have been affiliated with LDCT screening centers, which could have influenced the meetings.
To reach their conclusions, the pair looked at a random sample of 11,699 Medicare enrollees who had an SDM visit between January 2016 and Sept. 30, 2018. Of the patients who underwent an LDCT exam, nearly 92% did so within three months of their visit, prompting the team to use that cutoff for their report.
Broken down by specialty, SDM visits with radiologists resulted in the highest rate of subsequent screening at 93%, followed by nurse practitioners (80.1%), pulmonary specialists (56.4%) and family physicians (53.5%). The latter group was used as a reference for odds ratios.
And patients who met with a new clinician more often opted to complete low-dose CT screening compared to those who had a prior relationship with their doctor (75% versus 55%).
As it stands, the Centers for Medicare & Medicaid Services mandates a patient-provider visit prior to deciding on LDCT in order to receive reimbursement. And the United States Preventive Services Task Force currently recommends such meetings.
Despite this, the authors said it is “surprising” that the overall rate of SDM visits remains very low.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.