PDF(Pubmed)
Abstract：
OBJECTIVE: Many individuals who are eligible for lung cancer screening have comorbid conditions complicating their shared decision-making conversations with physicians. The goal of our study was to better understand how primary care physicians (PCPs) factor comorbidities into their evaluation of the risks and benefits of lung cancer screening and into their shared decision-making conversations with patients.
METHODS: We conducted semistructured interviews by videoconference with 15 PCPs to assess the extent of shared decision-making practices and explore their understanding of the intersection of comorbidities and lung cancer screening, and how that understanding informed their clinical approach to this population.
RESULTS: We identified 3 themes. The first theme was whether to discuss or not to discuss lung cancer screening. PCPs described taking additional steps for individuals with complex comorbidities to decide whether to initiate this discussion and used subjective clinical judgment to decide whether the conversation would be productive and beneficial. PCPs made mental assessments that factored in the patient\'s health, life expectancy, quality of life, and access to support systems. The second theme was that shared decision making is not a simple discussion. When PCPs did initiate discussions about lung cancer screening, although some believed they could provide objective information, others struggled with personal biases. The third theme was that ultimately, the decision to be screened was up to the patient. Patients had the final say, even if their decision was discordant with the PCP\'s advice.
CONCLUSIONS: Shared decision-making conversations about lung cancer screening differed substantially from the standard for patients with complex comorbidities. Future research should include efforts to characterize the risks and benefits of LCS in patients with comorbidities to inform guidelines and clinical application.
METHODS: We conducted semistructured interviews by videoconference with 15 PCPs to assess the extent of shared decision-making practices and explore their understanding of the intersection of comorbidities and lung cancer screening, and how that understanding informed their clinical approach to this population.
RESULTS: We identified 3 themes. The first theme was whether to discuss or not to discuss lung cancer screening. PCPs described taking additional steps for individuals with complex comorbidities to decide whether to initiate this discussion and used subjective clinical judgment to decide whether the conversation would be productive and beneficial. PCPs made mental assessments that factored in the patient\'s health, life expectancy, quality of life, and access to support systems. The second theme was that shared decision making is not a simple discussion. When PCPs did initiate discussions about lung cancer screening, although some believed they could provide objective information, others struggled with personal biases. The third theme was that ultimately, the decision to be screened was up to the patient. Patients had the final say, even if their decision was discordant with the PCP\'s advice.
CONCLUSIONS: Shared decision-making conversations about lung cancer screening differed substantially from the standard for patients with complex comorbidities. Future research should include efforts to characterize the risks and benefits of LCS in patients with comorbidities to inform guidelines and clinical application.
摘要：
目的：许多有资格接受肺癌筛查的人患有合并症，使他们与医生的共同决策对话变得复杂。我们研究的目的是更好地了解初级保健医生（PCP）如何将合并症纳入他们对肺癌筛查的风险和收益的评估以及与患者的共同决策对话中。
方法：我们通过视频会议与15个PCP进行了半结构化访谈，以评估共同决策实践的程度，并探讨他们对合并症和肺癌筛查的交集的理解。以及这种理解如何为他们对这一人群的临床方法提供信息。
结果：我们确定了3个主题。第一个主题是是否讨论肺癌筛查。PCP描述了为具有复杂合并症的个体采取其他步骤来决定是否发起此讨论，并使用主观临床判断来决定对话是否富有成效和有益。PCP进行了心理评估，将患者的健康状况考虑在内，预期寿命,生活质量,和获得支持系统。第二个主题是共同决策不是简单的讨论。当PCP确实开始讨论肺癌筛查时，尽管有些人认为他们可以提供客观信息，其他人与个人偏见作斗争。第三个主题是，最终，筛选的决定取决于患者.病人说了算,即使他们的决定与PCP的建议不一致。
结论：关于肺癌筛查的共同决策对话与复杂合并症患者的标准有很大不同。未来的研究应包括努力描述合并症患者LCS的风险和益处，以指导指南和临床应用。
方法：我们通过视频会议与15个PCP进行了半结构化访谈，以评估共同决策实践的程度，并探讨他们对合并症和肺癌筛查的交集的理解。以及这种理解如何为他们对这一人群的临床方法提供信息。
结果：我们确定了3个主题。第一个主题是是否讨论肺癌筛查。PCP描述了为具有复杂合并症的个体采取其他步骤来决定是否发起此讨论，并使用主观临床判断来决定对话是否富有成效和有益。PCP进行了心理评估，将患者的健康状况考虑在内，预期寿命,生活质量,和获得支持系统。第二个主题是共同决策不是简单的讨论。当PCP确实开始讨论肺癌筛查时，尽管有些人认为他们可以提供客观信息，其他人与个人偏见作斗争。第三个主题是，最终，筛选的决定取决于患者.病人说了算,即使他们的决定与PCP的建议不一致。
结论：关于肺癌筛查的共同决策对话与复杂合并症患者的标准有很大不同。未来的研究应包括努力描述合并症患者LCS的风险和益处，以指导指南和临床应用。
