Opening the Black Box of Communication and Decision-Making for Lung Cancer Screening and Nodule Evaluation Implications for Policy and Practice

摘要

In 2015, the Center for Medicare and Medicaid Services (CMS) issued a groundbreaking coverage determination requiring a documented shared decision-making discussion including use of a patient decision aid to receive reimbursement for low-dose computed tomography (LDCT) screening for lung cancer. This requirement was supported by a large body of literature in other clinical contexts, suggesting that shared decision-making facilitated by decision aids increases patient knowledge, reduces decisional conflict, improves accuracy of expectations, and aligns care with patients' values (1). Yet many questioned whether the CMS ruling was appropriate: no other preventive health measure has such a requirement, and little was known about communication and decision-making for LDCT screening or the effectiveness of decision aids in this context (2, 3).