Marilyn M Schapira1,2, Keri L Rodriguez3,4, Sumedha Chhatre1,5, Liana Fraenkel6,7, Lori A Bastian6,7, Jeffrey D Kravetz6,7, Onur Asan8, Scott Akers9, Anil Vachani10,11, Jason M Prigge1, Jessica Meline1, Jennifer V Ibarra6, Barbara Corn6, Dana Kaminstein1,12. 1. The Center for Health Equity Research and Promotion (CHERP) at the Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia, PA, USA. 2. Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. 3. CHERP, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. 4. Department of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 5. The Department of Psychiatry, the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. 6. VA Connecticut Healthcare System, West Haven, CT, USA. 7. Yale University School of Medicine, New Haven, CT, USA. 8. The Stevens Institute of Technology, School of Systems and Enterprises, Hoboken, NJ, USA. 9. Department of Radiology, The Michael J. Crescenz VA Medical Center and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. 10. The Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA. 11. Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. 12. Organizational Dynamics, Liberal and Professional Studies, School of Arts & Sciences, University of Pennsylvania, Philadelphia, PA, USA.
Abstract
BACKGROUND: A shared decision-making (SDM) process for lung cancer screening (LCS) includes a discussion between clinicians and patients about benefits and potential harms. Expert-driven taxonomies consider mortality reduction a benefit and consider false-positives, incidental findings, overdiagnosis, overtreatment, radiation exposure, and direct and indirect costs of LCS as potential harms. OBJECTIVE: To explore whether patients conceptualize the attributes of LCS differently from expert-driven taxonomies. DESIGN: Cross-sectional study with semistructured interviews and a card-sort activity. PARTICIPANTS: Twenty-three Veterans receiving primary care at a Veterans Affairs Medical Center, 55 to 73 y of age with 30 or more pack-years of smoking. Sixty-one percent were non-Hispanic African American or Black, 35% were non-Hispanic White, 4% were Hispanic, and 9% were female. APPROACH: Semistructured interviews with thematic coding. MAIN MEASURES: The proportion of participants categorizing each attribute as a benefit or harm and emergent themes that informed this categorization. KEY RESULTS: In addition to categorizing reduced lung cancer deaths as a benefit (22/23), most also categorized the following as benefits: routine annual screening (8/9), significant incidental findings (20/23), follow-up in a nodule clinic (20/23), and invasive procedures (16/23). Four attributes were classified by most participants as a harm: false-positive (13/22), overdiagnosis (13/23), overtreatment (6/9), and radiation exposure (20/22). Themes regarding the evaluation of LCS outcomes were 1) the value of knowledge about body and health, 2) anticipated positive and negative emotions, 3) lack of clarity in terminology, 4) underlying beliefs about cancer, and 5) risk assessment and tolerance for uncertainty. CONCLUSIONS: Anticipating discordance between patient- and expert-driven taxonomies of the benefits and harms of LCS can inform the development and interpretation of value elicitation and SDM discussions.
BACKGROUND: A shared decision-making (SDM) process for lung cancer screening (LCS) includes a discussion between clinicians and patients about benefits and potential harms. Expert-driven taxonomies consider mortality reduction a benefit and consider false-positives, incidental findings, overdiagnosis, overtreatment, radiation exposure, and direct and indirect costs of LCS as potential harms. OBJECTIVE: To explore whether patients conceptualize the attributes of LCS differently from expert-driven taxonomies. DESIGN: Cross-sectional study with semistructured interviews and a card-sort activity. PARTICIPANTS: Twenty-three Veterans receiving primary care at a Veterans Affairs Medical Center, 55 to 73 y of age with 30 or more pack-years of smoking. Sixty-one percent were non-Hispanic African American or Black, 35% were non-Hispanic White, 4% were Hispanic, and 9% were female. APPROACH: Semistructured interviews with thematic coding. MAIN MEASURES: The proportion of participants categorizing each attribute as a benefit or harm and emergent themes that informed this categorization. KEY RESULTS: In addition to categorizing reduced lung cancer deaths as a benefit (22/23), most also categorized the following as benefits: routine annual screening (8/9), significant incidental findings (20/23), follow-up in a nodule clinic (20/23), and invasive procedures (16/23). Four attributes were classified by most participants as a harm: false-positive (13/22), overdiagnosis (13/23), overtreatment (6/9), and radiation exposure (20/22). Themes regarding the evaluation of LCS outcomes were 1) the value of knowledge about body and health, 2) anticipated positive and negative emotions, 3) lack of clarity in terminology, 4) underlying beliefs about cancer, and 5) risk assessment and tolerance for uncertainty. CONCLUSIONS: Anticipating discordance between patient- and expert-driven taxonomies of the benefits and harms of LCS can inform the development and interpretation of value elicitation and SDM discussions.
Entities:
Keywords:
card-sort activity; lung cancer screening; patient values; shared decision making; value elicitation
Authors: Marilyn M Schapira; Sumedha Chhatre; Jason M Prigge; Jessica Meline; Dana Kaminstein; Keri L Rodriguez; Liana Fraenkel; Jeffrey D Kravetz; Jeff Whittle; Lori A Bastian; Anil Vachani; Scott Akers; Susan Schrand; Jennifer V Ibarra; Onur Asan Journal: JMIR Form Res Date: 2022-04-08
Authors: Christine M Gunn; Ariel Maschke; Michael K Paasche-Orlow; Ashley J Housten; Nancy R Kressin; Mara A Schonberg; Tracy A Battaglia Journal: MDM Policy Pract Date: 2021-07-20