Experts highlight 'suboptimal' rates of CMS-required shared decision making encounters prior to LDCT

Despite the U.S. Centers for Medicare and Medicaid Services requiring counseling encounters prior to lung cancer screening, shared decision-making remains under documented. 

A study recently published in the Journal of the American College of Radiology disclosed that less than half of individuals who underwent CT lung cancer screening (LCS) in their cohort had the required shared decision-making encounter documented in their electronic health record (EHR).[1] Additionally, only 21.8% of the records included all Medicare-designated components. Experts involved in the research suggested these findings underscore the need for better implementation of shared decision-making (SDM) models, as well as more thorough counseling documentation, as coverage for LDCT is dependent on these factors. 

“SDM is a fundamental tenet of LCS, intended to ensure that an individual’s preferences are incorporated into the LCS decision through a balanced discussion of an individual’s risk versus benefits,” corresponding author Louise M. Henderson, PhD, from the Department of Radiology at the University of North Carolina, and co-authors explained. “The SDM visit is a multicomponent patient-clinician encounter, which per Medicare coverage requirements includes the use of an LCS decision-making aid, discussion of benefits and potential harms of LCS, counseling on the importance of LCS adherence, discussion of comorbidities, including an individual’s ability or willingness to undergo treatment for lung cancer, and counseling on smoking cessation and maintenance.” 

This study analyzed the electronic health records of 580 individuals who underwent lung cancer screenings at 4 LCS centers between February 2015 and June 2020. Through these records, experts examined the frequency of EHR-documented SDM, as well as adherence to all Medicare-designated SDM components.