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. 

Out of the 580 screened individuals, 243 (41.9%) had EHR-documented SDM. Self-reported SDM was higher, occurring in 295 (71.1%) of those who completed the cancer screening. However, only 53 (21.8%) of the records included all Medicare-designated components. 

Specialists, such as pulmonologists, were more likely to document SDM, the researchers noted. Similar trends were observed in referring clinicians treating patients with greater body mass and in current or former smokers. 

“Given the central role of SDM in individual screening decisions, efforts are necessary to ensure that SDM is not only occurring but occurring in a manner that is effective and informative,” the authors wrote. “Given radiologists’ expertise in LDCT interpretation, lung neoplasm detection, and screening-related risks such as radiation, they have a significant opportunity to help provide education before LCS and help in strategies for improving individuals’ understanding of LCS results.” 

Although the researchers described EHR-documented SDM rates as “suboptimal,” they did note that their results indicate that these numbers appear to have increased from previous lows reported in other studies. 

The detailed research can be viewed in the Journal of the American College of Radiology

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Reference:

1. Tina Tailor, M. Patricia Rivera, Danielle D. Durham, Pasangi Perera, Lindsay Lane, Louise M. Henderson. Prospective Multisite Cohort Study to Evaluate Shared Decision Making Utilization Among Individuals Screened for Lung Cancer. Journal of the American College of Radiology. Published April 16, 2022. DOI:https://doi.org/10.1016/j.jacr.2022.03.005

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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.

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