• Amir Alishahi Tabriz, Christine Neslund-Dudas, Kea Turner, M Patricia Rivera, Daniel S Reuland, and Elston Lafata Jennifer J Eshelman School of Pharmacy, Chapel Hill, NC; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Henry Ford Health System, Detroit, MI..
• Eshelman School of Pharmacy, Chapel Hill, NC.
• Chest. 2021 Jan 1; 159 (1): 413-425.

BackgroundThe Centers for Medicare and Medicaid Services stipulate shared decision-making (SDM) counseling as a prerequisite to lung cancer screening (LCS) reimbursement, despite well-known challenges implementing SDM in practice.Research QuestionHow have health-care organizations implemented SDM for LCS?Study Design And MethodsFor this qualitative study, we used data from in-depth, semistructured interviews with key informants directly involved in implementing SDM for LCS, managing SDM for LCS, or both. We identified respondents using a snowball sampling technique and used template analysis to identify and analyze responses thematically.ResultsWe interviewed 30 informants representing 23 health-care organizations located in 12 states and 4 Census regions. Respondents described two types of SDM for LCS programs: centralized models (n = 7), in which front-end practitioners (eg, primary care providers) referred patients to an LCS clinic where trained staff (eg, advanced practice nurses) delivered SDM at the time of screening, or decentralized models (n = 10), in which front-end practitioners delivered SDM before referring patients for screening. Some organizations used both models simultaneously (n = 6). Respondents discussed tradeoffs between SDM quality and access. They perceived centralized models as enhancing SDM quality, but limiting patient access to care, and vice versa. Respondents reported ongoing challenges with limited resources and budgetary constraints, ambiguity regarding what constitutes SDM, and an absence of benchmarks for evaluating SDM for LCS quality.InterpretationThose responsible for developing and managing SDM for LCS programs voiced concerns regarding both patient access and SDM quality, regardless of organizational context, or the SDM for LCS model implemented. The challenge facing these organizations, and those wanting to help patients and clinicians balance the tradeoffs inherent with LCS, is how to move beyond a check-box documentation requirement to a process that enables LCS to be offered to all high-risk patients, but used only by those who are informed and for whom screening represents a value-concordant service.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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