When Is a Harm a Harm? Discordance between Patient and Medical Experts' Evaluation of Lung Cancer Screening Attributes.
card-sort activity
lung cancer screening
patient values
shared decision making
value elicitation
Journal
Medical decision making : an international journal of the Society for Medical Decision Making
ISSN: 1552-681X
Titre abrégé: Med Decis Making
Pays: United States
ID NLM: 8109073
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
pubmed:
9
2
2021
medline:
26
11
2021
entrez:
8
2
2021
Statut:
ppublish
Résumé
A shared decision-making (SDM) process for lung cancer screening (LCS) includes a discussion between clinicians and patients about benefits and potential harms. Expert-driven taxonomies consider mortality reduction a benefit and consider false-positives, incidental findings, overdiagnosis, overtreatment, radiation exposure, and direct and indirect costs of LCS as potential harms. To explore whether patients conceptualize the attributes of LCS differently from expert-driven taxonomies. Cross-sectional study with semistructured interviews and a card-sort activity. Twenty-three Veterans receiving primary care at a Veterans Affairs Medical Center, 55 to 73 y of age with 30 or more pack-years of smoking. Sixty-one percent were non-Hispanic African American or Black, 35% were non-Hispanic White, 4% were Hispanic, and 9% were female. Semistructured interviews with thematic coding. The proportion of participants categorizing each attribute as a benefit or harm and emergent themes that informed this categorization. In addition to categorizing reduced lung cancer deaths as a benefit (22/23), most also categorized the following as benefits: routine annual screening (8/9), significant incidental findings (20/23), follow-up in a nodule clinic (20/23), and invasive procedures (16/23). Four attributes were classified by most participants as a harm: false-positive (13/22), overdiagnosis (13/23), overtreatment (6/9), and radiation exposure (20/22). Themes regarding the evaluation of LCS outcomes were 1) the value of knowledge about body and health, 2) anticipated positive and negative emotions, 3) lack of clarity in terminology, 4) underlying beliefs about cancer, and 5) risk assessment and tolerance for uncertainty. Anticipating discordance between patient- and expert-driven taxonomies of the benefits and harms of LCS can inform the development and interpretation of value elicitation and SDM discussions.
Sections du résumé
BACKGROUND
A shared decision-making (SDM) process for lung cancer screening (LCS) includes a discussion between clinicians and patients about benefits and potential harms. Expert-driven taxonomies consider mortality reduction a benefit and consider false-positives, incidental findings, overdiagnosis, overtreatment, radiation exposure, and direct and indirect costs of LCS as potential harms.
OBJECTIVE
To explore whether patients conceptualize the attributes of LCS differently from expert-driven taxonomies.
DESIGN
Cross-sectional study with semistructured interviews and a card-sort activity.
PARTICIPANTS
Twenty-three Veterans receiving primary care at a Veterans Affairs Medical Center, 55 to 73 y of age with 30 or more pack-years of smoking. Sixty-one percent were non-Hispanic African American or Black, 35% were non-Hispanic White, 4% were Hispanic, and 9% were female.
APPROACH
Semistructured interviews with thematic coding.
MAIN MEASURES
The proportion of participants categorizing each attribute as a benefit or harm and emergent themes that informed this categorization.
KEY RESULTS
In addition to categorizing reduced lung cancer deaths as a benefit (22/23), most also categorized the following as benefits: routine annual screening (8/9), significant incidental findings (20/23), follow-up in a nodule clinic (20/23), and invasive procedures (16/23). Four attributes were classified by most participants as a harm: false-positive (13/22), overdiagnosis (13/23), overtreatment (6/9), and radiation exposure (20/22). Themes regarding the evaluation of LCS outcomes were 1) the value of knowledge about body and health, 2) anticipated positive and negative emotions, 3) lack of clarity in terminology, 4) underlying beliefs about cancer, and 5) risk assessment and tolerance for uncertainty.
CONCLUSIONS
Anticipating discordance between patient- and expert-driven taxonomies of the benefits and harms of LCS can inform the development and interpretation of value elicitation and SDM discussions.
Identifiants
pubmed: 33554740
doi: 10.1177/0272989X20987221
doi:
Types de publication
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM