Physicians shortchanging patients in cancer-screening discussions, study finds

Despite national guidelines advising physicians to talk to high-risk patients about the benefits and harms of lung cancer screening, those discussions may not be occurring properly, a study published in JAMA Internal Medicine found.

The study, led by Chapel Hill-based University of North Carolina Lineberger Comprehensive Cancer Center researchers, looked at 14 audio-recorded office visit discussions between physicians and patients.

The quality of the conversation about lung cancer screening was "poor," and discussion of a screening's potential harm was "virtually nonexistent," the researchers found. On average, the physicians spent less than a minute talking about the issue, the study found.

"We're not taking a side as to whether lung cancer screening is good or bad, but there seems to be a consensus that we should be sharing these complex decisions with patients," said senior study author Daniel Reuland, MD. "Our fly-on-the-wall sample from real-world practice shows us that's not happening."

The research team analyzed 14 screening discussions from a large database of conversations between physicians and patients. They found the conversations by electronically searching 5,300 recorded interactions between physicians and age-eligible patients.

Only 14 conversations out of 137 that met keyword criteria addressed lung cancer screening specifically. The conversations were brief and one-sided, and none of the physicians discussed the potential harms of screening, the researchers found. No physician explained false positive test results or the potential need for additional imaging or invasive diagnostic procedures.

"We need to design systems that make patient care and medical decisions more informed and shared, and we need to take that responsibility seriously," Dr. Reuland said. "Issuing guidelines and payer-based regulations saying we should be doing shared decision-making is fine, but it isn't enough. Among other things, we need more efficient and reliable ways of getting patients involved in these decisions."

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