Experts Endorse CMS Requirements for Patient-Physician Decision-Making Prior to Lung Cancer Screening

A viewpoint perspective from 3 experts endorsed the requirement for a patient and their physician to engage in a shared discussion of benefits and harms before proceeding with a low-dose spiral computed tomography (LDCT) scan in order to prevent lung cancer death.

A viewpoint perspective from 3 experts, including a University of North Carolina (UNC) Lineberger Comprehensive Cancer Center researcher, endorsed the requirement put forward by the Centers for Medicare and Medicaid Services (CMS) for a patient and their physician to engage in a shared discussion of benefits and harms before proceeding with a low-dose spiral computed tomography (LDCT) scan in order to prevent lung cancer death.

Daniel Reuland, MD, MPH, one of the review authors, a member of the UNC Lineberger Comprehensive Cancer Center and a professor in the division of General Medicine and Clinical Epidemiology at UNC School of Medicine, said that as part of standard practice, a physician should ask directly about the patient’s informed values and preferences with regards to the key tradeoffs of screening in order to reach a decision properly fitted to the patient. The viewpoint authors argue that shared decision-making between physician and patient is more important than ever because it may lead to greater health equity by promoting patient engagement, tobacco cessation, and screening adherence.

"In our view, CMS should continue to require, as well as pay for, shared decision-making, including associated tobacco counseling for people being considered for annual lung cancer screening, because having yearly CT screening is a consequential decision," Reuland said in a press release.

The United States Preventive Services Task Force now recommends LDCT screening for those 50 to 80 years of age with a 20 pack-per-year smoking history. The newly expanded recommendations on who is eligible for screening now include a greater number of Black people, in response to research suggesting they have a higher risk of developing lung cancer at younger ages and with less exposure to tobacco.

The experts note that during the COVID-19 pandemic, many patients have effectively received medical advice through video call services, such as Skype or Zoom. They recommend that CMS continue to pay for counseling provided via telehealth. Reuland and others at UNC have tested a video decision-making tool and said that it provides patients eligible for screening with a better understanding of the risks and benefits.

REFERENCE

Experts recommend shared patient - doctor decision-making prior to lung cancer screening [news release]. EurekAlert; March 9, 2021. Accessed March 12, 2021. https://www.eurekalert.org/pub_releases/2021-03/ulcc-ers030921.php