Patient-doctor discussions about lung cancer screening need improvement

National lung cancer screening guidelines recommend discussing the benefits and harms of screening, but a new study found the quality of these conversations to be subpar.

Authors of the study published online Aug. 13 in JAMA Internal Medicine also found discussion of potential harms of screening were “virtually nonexistent,” said senior author Daniel Reuland, MD, and colleagues.

"We're not taking a side as to whether lung cancer screening is good or bad, but there seems to be a consensus that we should be sharing these complex decisions with patients," Reuland, director of the University of North Carolina Lineberger Comprehensive Cancer Center said in a statement. "Our fly-on-the-wall sample from real-world practice shows us that's not happening."

The team analyzed 14 audio-recorded conversations of office visits between doctors and patients regarding the initiation of lung cancer screening.

Of the 13:07 minute total average discussion, 59 seconds was spent discussing the screening. Reuland et al. found physicians “universally” recommended screening and none of the conversations met the minimum skill criteria for eight of the 12 shared decision-making (SDM) behaviors, such as “explains the pros and cons of options to the patient.”

The authors found no reference to decision aids or education materials in the conversations.

"A lot of people undergo surveillance, additional scanning, and some people undergo invasive procedures who don't have lung cancer," said Reuland. "The problem is weighing a small chance of benefit in the form of prolonged life versus a larger chance that a given patient will incur some kind of physical or psychological harm, plus out-of-pocket costs. It's important to talk about those potential harms and benefits with patients when deciding about screening."

Lung cancer remains the leading cause of cancer death in the U.S., according to the American Cancer Society. Since 2013, the U.S. Preventative Services Task Force (USPSTF) has recommended annual screening using low-dose CT in adults ages 55 to 80 years old who have smoked a minimum of 30 pack-years.

Additionally, the National Lung Screening Trial (NLST) determined detecting lung cancer early can reduce a person’s risk of mortality.

"Although the sample was small, the results were stark and confirmed what we thought we would find," Reuland said. "Shared decision making isn't happening in practice as well as it should or as well as we'd like to think it is. There's a big gap between what guidelines say and what actually happens."