Smokers’ views on uncertainty affect their actions around screening for lung cancer

In order for shared decision-making to illuminate clinical pathways for patients getting screened for lung cancer, healthcare providers need to take a systematic approach to understanding and addressing patients’ concerns about a common source of consternation: uncertainty.

The findings supporting this conclusion posted online Sept. 27 in Annals of the American Thoracic Society.

Marilyn Schapira, MD, MPH, of the University of Pennsylvania and the Philadelphia VA Medical Center and colleagues conducted structured interviews of 22 current and former cigarette smokers recruited from primary care and pulmonary practices in Philadelphia.

Sixty-eight percent of the participants were male, 72 percent were Black or African American, and half met U.S. Preventive Services Task Force criteria for lung cancer screening.

The querying incorporated prompts related to benefits, harms and responses to general and specific types of uncertainty associated with lung cancer screening.

The team had the interview transcripts independently coded by two investigators, then analyzed the results and identified major themes and insights.

Most noteworthy among these were:

• The desire to decrease uncertainty may motivate lung cancer screening decisions.  
• Uncertainty is an attribute of health states that impacts how patients weigh benefits and harms of lung cancer screening.
• Patient understanding and tolerance of uncertainty varies across statistical, evidentiary and stochastic (i.e., randomly prompted) uncertainty.
• Provider-patient communication may mitigate intolerance of uncertainty in the context of lung cancer screening.

“Radiographic lung cancer screening guidelines and coverage requirements warrant a shared decision making process,” Schapira and co-authors write. “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 authors state their wish that their findings help inform provider-patient communication strategies around the decision to perform radiographic lung cancer screening.