On February 5, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a final national coverage determination that provides Medicare coverage of screening for lung cancer with low dose computed tomography (LDCT) for high risk patients. CMS will cover lung cancer screening with LDCT once per year for Medicare and Medicaid beneficiaries who meet certain criteria.

In order for CMS to pay for LDCT lung cancer screening, the patient and their health care provider (HCP) must engage in “shared decision making” before the screening–CMS requires them to discuss risks and benefits of screening, including follow-up testing that might occur if nodules are discovered, radiation exposure from the scan, and the possibility of false positives (nodules identified as lung cancer when the patient doesn’t actually have lung cancer).

As CMS states in its decision memo:

“Shared decision making is important for persons within the population for whom screening is recommended.  The benefit of screening varies with risk because persons who are at higher risk because of smoking history or other risk factors are more likely to benefit.  Screening cannot prevent most lung cancer deaths, and smoking cessation remains essential.  Lung cancer screening has substantial harms, most notably the risk for false-positive results and incidental findings that lead to a cascade of testing and treatment that may result in more harm, including the anxiety of living with a lesion that may be cancer.  Over-diagnosis of lung cancer and the risks of radiation are real harms, although their magnitude is uncertain.  The decision to begin screening should be the result of a thorough discussion of the possible benefits, limitations, and known and uncertain harms.”

But what is shared decision making?  How is it different from the usual patient-HCP encounter?

In the traditional method of medical decision making, the doctors might meet in a closed room, come to a consensus, then tell the patient what they will do.  With shared decision making, the healthcare provider and patient meet, go over a detailed account of risks and benefits, and make a decision together with consideration of the patient’s perspective and preferences.

Dr. Victor Montori (@vmontori), Professor of Medicine at the Mayo Clinic and expert on shared decision making, states: “Shared decision making makes the options available clear, empowers the patient to consider their options and express their goals.”  Dr. Montori’s video on youtube provides a nice description of shared decision making and its importance.

During #LCSM Chat on April 9, 2015, we will discuss what CMS-required shared decision making (#sdm) may look like prior to lung cancer screening with LDCT.  Our moderator, Dr. David Tom Cooke (@DavidCookeMD) will address the following topics.

T1: What does shared decision making (#sdm) for #lungcancer screening mean in the patient perspective? HCP perspective?  #LCSM

T2: What #LDCT concepts are most important during #sdm? False Positive? False Negative? Rate of true #lungcancer? Radiation exposure? #LCSM

T3: What shared decision making (#sdm) tools are available for discussing #LDCT?  What are their strengths and weaknesses? #LCSM

T4: Which graphics best illustrate risks & benefits of #LDCT & the likelihood of actually finding #lungcancer?  #LCSM #sdm

Please remember to include #LCSM in ALL your tweets so the other chat participants can see them.  You can read a primer on participating in the chat here.  Note that #sdm is a healthcare hashtag registered on symplur.com to denote shared decision making. It is not necessary to include #sdm in your tweets to participate in this chat, but including it will make this discussion more visible to the large Twitter community interested in shared decision making.  #LDCT is the hashtag registered on symplur.com to denote lung cancer screening with LDCT.

We look forward to an enriching and educational conversation with the #LCSM Community!

References

NLST Patient & HCP Shared Decision Tool

Shared Decision Making: An Interview with Mayo Clinic Professor of Medicine Victor Montori

Symplur analytics for #sdm (shared decision making)

Centers for Medicare and Medicaid Services:  Decision Memo for Screening for Lung Cancer with Low Dose Computed Tomography (LDCT) (CAG-00439N)

JAMA: Competing Mortality in Cancer Screening–A Teachable Moment

Visualizing Health: A Scientifically Vetted Style Guide for Communicating Health Data

Shared Decision Making Aid for Lung Cancer Screening Discussion