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P3.11-10 Lung Cancer Screening Shared Decision Making: Decision-Aid for the Patient

      Background

      Despite general agreement in the U.S. that lung cancer screening (LCS) is effective and safe, with availability of insurance coverage for those at high-risk, screening uptake is less than 5%. Patients in Medicare and Medicaid (CMS) must participate in "shared decision making" (SDM) with a primary care giver and a "decision-aid" (DA) used. A major potential contributor to low LCS uptake is inaccurate and difficult to understand information on LCS benefits and risks contained in currently-available DAs. A gratuitous example is the statement "4 of 5 patients slip through to die of LC". We offer a new DA that provides information required by CMS, based upon lessons learned from twenty years research and clinical experience in the International Early Lung Cancer Action Program (IELCAP), and reflected in the LCS guideline of the National Comprehensive Cancer Network (NCCN).

      Method

      Currently available DAs used in LCS were reviewed and compared with published results from LCS programs participating in IELCAP and NCCN with findings distilled to provide information required by CMS and understandable by patients of average intelligence.

      Result

      When an individual with NCCN risk criteria levels 1 or 2 receives a low-dose CT scan annually, as a participant in a screening program using the IELCAP or NCCN diagnostic guidelines, and reliably follows recommendations for further testing or treatment, benefits and risks described herein may be confidently anticipated. Based on recent data from LCS at the Lahey Clinic, with optimal uptake, 12.5% 1 in 8) of those screened will be diagnosed with LC over a decade, more than 80% in early stage. At baseline screen 10.4% will have a positive test result but not be diagnosed with LC during that screening cycle (false-positive). Subsequent annual repeat scans will have 5% false positives. In IELCAP centers actuarial ten-year LC-specific survival exceeds 80% after diagnosis of LC. Application of IELCAP's algorithm results in invasive biopsy or surgical resection of benign nodules in less than 10%. Patients diagnosed by LCS are increasingly treated with minimally-invasive, sub-lobar resections that offer equivalent survival with less morbidity. Fewer than 1% die after surgery. Benefits of screening will diminish and disappear over time if annual screening stops. Higher risks may be experienced if diagnostic and treatment decisions deviate from those recommended.

      Conclusion

      If patients at high risk of LC participate in SDM using the DA presented, it can be confidently anticipated that LCS uptake will increase, with increased future survival and reduced LC mortality.

      Keywords

      shared decision making, decision aid, lung cancer screening