Tina D Tailor1, M Patricia Rivera2, Danielle D Durham3, Pasangi Perera3, Lindsay Lane3, Louise M Henderson4. 1. Fellowship Director, Cardiothoracic Radiology and Research Director, Duke Lung Cancer Screening Program, Department of Radiology, Duke University, Durham, North Carolina. 2. Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina; Director, Multidisciplinary Lung Cancer Screening Program and Co-Director, North Carolina Lung Screening Registry, University of North Carolina, Chapel Hill, North Carolina. 3. Department of Radiology, University of North Carolina, Chapel Hill, North Carolina. 4. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina; Department of Radiology, University of North Carolina, Chapel Hill, North Carolina; Program Co-Lead, Cancer Epidemiology Program, Co-Director, North Carolina Lung Screening Registry, and Director, Radiologic Sciences Faculty Development, Radiology Department, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina. Electronic address: louise_henderson@med.unc.edu.
Abstract
PURPOSE: The aim of this study was to determine the frequency, components of, and factors associated with shared decision-making (SDM) discussions according to electronic health record (EHR) documentation among individuals undergoing lung cancer screening (LCS). METHODS: A prospective observational cohort study was conducted of individuals undergoing LCS between February 2015 and June 2020 at four LCS centers. The primary outcome was EHR-documented SDM, defined using Medicare-designated components. A multivariable logistic regression model was used to examine predictors of EHR-documented SDM. A secondary outcome was agreement of individual's self-report of SDM and EHR-documented SDM, evaluated using Cohen's κ statistic. RESULTS: Among screened individuals, 41.9% (243 of 580) had EHR-documented SDM, and 71.1% (295 of 415) had self-reported SDM. Decision aids were used in 55.6% of EHR-documented SDM encounters (135 of 243), and 21.8% of documented SDM encounters (53 of 243) included all Medicare-designated components. SDM was documented more frequently in individuals with body mass index ≥ 25 versus <25 kg/m2 (adjusted odds ratio [aOR], 1.63; 95% confidence interval [CI], 1.05-2.52) and in currently versus formerly smoking individuals (aOR, 1.53; 95% CI, 1.02-2.32). Nonpulmonary referring clinicians were less likely to document SDM than pulmonary clinicians (internal medicine: aOR, 0.32; 95% CI, 0.18-0.53; family medicine: aOR, 0.08; 95% CI, 0.04-0.14; other specialties: aOR, 0.08; 95% CI, 0.03-0.21). In a subset of 415 individuals, there was little agreement between individual self-report of SDM and EHR-documented SDM (κ = 0.184), with variation in agreement on the basis of referring clinician specialty. CONCLUSIONS: Although EHR-documented SDM occurred in fewer than half of individuals undergoing LCS, self-reported SDM rates were higher, suggesting that SDM may be underdocumented in the EHR. In addition, EHR-documented SDM was more likely in individuals with higher body mass index and those referred for LCS by pulmonary clinicians. These findings indicate areas for improvement in the implementation and documentation of SDM.
PURPOSE: The aim of this study was to determine the frequency, components of, and factors associated with shared decision-making (SDM) discussions according to electronic health record (EHR) documentation among individuals undergoing lung cancer screening (LCS). METHODS: A prospective observational cohort study was conducted of individuals undergoing LCS between February 2015 and June 2020 at four LCS centers. The primary outcome was EHR-documented SDM, defined using Medicare-designated components. A multivariable logistic regression model was used to examine predictors of EHR-documented SDM. A secondary outcome was agreement of individual's self-report of SDM and EHR-documented SDM, evaluated using Cohen's κ statistic. RESULTS: Among screened individuals, 41.9% (243 of 580) had EHR-documented SDM, and 71.1% (295 of 415) had self-reported SDM. Decision aids were used in 55.6% of EHR-documented SDM encounters (135 of 243), and 21.8% of documented SDM encounters (53 of 243) included all Medicare-designated components. SDM was documented more frequently in individuals with body mass index ≥ 25 versus <25 kg/m2 (adjusted odds ratio [aOR], 1.63; 95% confidence interval [CI], 1.05-2.52) and in currently versus formerly smoking individuals (aOR, 1.53; 95% CI, 1.02-2.32). Nonpulmonary referring clinicians were less likely to document SDM than pulmonary clinicians (internal medicine: aOR, 0.32; 95% CI, 0.18-0.53; family medicine: aOR, 0.08; 95% CI, 0.04-0.14; other specialties: aOR, 0.08; 95% CI, 0.03-0.21). In a subset of 415 individuals, there was little agreement between individual self-report of SDM and EHR-documented SDM (κ = 0.184), with variation in agreement on the basis of referring clinician specialty. CONCLUSIONS: Although EHR-documented SDM occurred in fewer than half of individuals undergoing LCS, self-reported SDM rates were higher, suggesting that SDM may be underdocumented in the EHR. In addition, EHR-documented SDM was more likely in individuals with higher body mass index and those referred for LCS by pulmonary clinicians. These findings indicate areas for improvement in the implementation and documentation of SDM.
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