Many individuals eligible for lung cancer screening (LCS) also suffer from multiple health issues at the same time, known as comorbid conditions. This study explores how primary care physicians (PCPs) factor comorbidities into their shared decision-making conversations with patients to discuss the harms and benefits of lung cancer screening.

Researchers conducted semi-structured interviews with 15 PCPs affiliated with the Mount Sinai Health System in New York City between October 2020 and February 2021. PCPs were asked questions to examine their understanding of how comorbidities influence LCS and explored the presence/extent of shared decision-making discussions in the context of comorbidities. The researchers found that LCS shared decision-making conversations differed substantially with patients with complex comorbidities.

The findings indicate three themes: (1) To discuss or not to discuss—PCPs describe making clinical judgments to assess whether the patient is a good candidate for LCS before approaching the patient for a shared decision-making conversation. PCPs made mental assessments which factored in the patient’s current health, life expectancy, quality of life, and access to support systems. (2) Shared decision making is not a simple discussion—when PCPs did initiate LCS discussions, while some felt they could provide objective information, others struggled with personal biases. (3) Ultimately, the decision is up to the patient—patients ultimately made their own decisions, even if the decision conflicted with advice from the PCP.

The United States Preventive Services Task Force (USPSTF) guidelines recommend LCS with an annual low-dose computed tomography of the chest for individuals who meet age and smoking history criteria. The USPSTF rates this recommendation as “Grade B,” suggesting that health care clinicians offer or provide LCS to patients as part of their routine care, yet only 5.8% of eligible patients undergo LCS annually. Comorbid conditions add complexity to discussions on the risks and benefits of LCS.

The researchers believe this is the first study to characterise how PCPs consider chronic diseases and fitness for LCS in the context of comorbidities. Their findings support the call for continued research to determine the specific impact of comorbidities on LCS benefit and harm, as well as its clinical application. PCPs need more evidence-based information on LCS in cases of complex comorbidities to be able to effectively conduct shared decision-making discussions with these patients. The study calls for future research to include efforts to characterise the benefits and harms of LCS in patients with comorbidities to inform guidelines and clinical application.

Source: American Academy of Family Physicians