How Patients View Lung Cancer Screening. The Role of Uncertainty in Medical Decision Making.
Radiographic lung cancer screening guidelines and coverage requirements warrant a shared decision-making process. Guidance is needed regarding how to conduct shared decision making effectively. A useful organizing theme should include consideration of a patient's response to and tolerance of uncertainty associated with lung cancer screening.



The objectives of this study are to: (1) describe how patients respond to specific categories of uncertainty in the context of lung cancer screening, and (2) inform strategies for addressing concerns about uncertainty as part of the shared decision making.



We performed two series of structured interviews on participants in a convenience sample of current or former cigarette smokers recruited from primary care and pulmonary practices in Philadelphia. An interview guide included prompts related to benefits, harms, and responses to general and specific types of uncertainty (stochastic, statistical, and evidentiary) associated with lung cancer screening. Interviews were audio-recorded, transcribed, and independently coded by two investigators. An inductive analysis was conducted, and major themes were identified.



Twenty-two adults participated in the study. Sixty-eight percent were men, 72% were black or African American, and 50% met U.S. Preventive Services Task Force criteria for lung cancer screening. The primary themes to emerge from our study were: (1) the desire to decrease uncertainty may motivate lung cancer screening decisions; (2) uncertainty is an attribute of health states that impacts how patients weigh benefits and harms of lung cancer screening; (3) patient understanding and tolerance of uncertainty varies across stochastic, statistical, and evidentiary uncertainty; and (4) provider-patient communication may mitigate intolerance of uncertainty in the context of lung cancer screening.



A systematic approach to understanding and addressing patients' concerns about uncertainty in the context of lung cancer screening can guide a patient-centered approach to shared decision making. The results of this study can inform provider-patient communication strategies regarding the decision to perform radiographic lung cancer screening.
1 Division of General Internal Medicine.|2 Center for Health Equity Research and Promotion.
Marilyn M
MM
Schapira
3 Division of Hematology and Oncology, and.
Charu
C
Aggarwal
5 Department of Radiology, and.|4 Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
Scott
S
Akers
1 Division of General Internal Medicine.
Jaya
J
Aysola
1 Division of General Internal Medicine.
Diana
D
Imbert
3 Division of Hematology and Oncology, and.
Corey
C
Langer
6 Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Charlie B
CB
Simone
1 Division of General Internal Medicine.
Emily
E
Strittmatter
7 Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, and.|4 Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
Anil
A
Vachani
8 Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut; and.|9 Department of Medicine, Yale University, New Haven, Connecticut.
Liana
L
Fraenkel
D000368:Aged; D003142:Communication; D003657:Decision Making; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D015143:Philadelphia; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D011859:Radiography; D035501:Uncertainty
ambiguity; communication; decision making; lung cancer screening; uncertainty
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