A Prospective Cohort Study of Shared Decision Making in Lung Cancer Diagnostics: Impact of Using a Patient Decision Ai

Stine Rauff Søndergaard, Poul Henning Madsen, Ole Hilberg, Karina Mølgaard Jensen, Karina Olling, Karina Dahl Steffensen

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021 - A Prospective Cohort Study of Shared Decision Making in Lung Cancer Diagnostics: Impact of Using a Patient Decision Aid
Stine R Søndergaard1, Poul Henning Madsen2, Ole Hilberg1,5, Karina M Jensen1, Karina Olling4, Karina D Steffensen3,4,5

Background and aim
Patients referred to fast-track evaluation with suspicion of lung malignancy are, based on CT scans, most often recommended further evaluation to establish diagnosis. However, in a significant number of the patients lung cancer is not very likely but at the same time cannot be ruled out based on the CT scan and referral note. In this group of patients it is not scientifically clear whether to recommend further diagnostic, invasive procedures with potential risks involved, arrange close follow- up with regular CT scans, or deselect further evaluation. Guidelines have encouraged the use of Shared Decision Making (SDM) to engage patients in the decision on the intensity of the diagnostic process, but the practice is not consistent among pulmonologists. With its systematic approach, SDM can help clinicians engage their patients to ensure that decision making is based on patient preferences as well as evidence based clinical information.
The aim of this study was to investigate the impact on patient-reported outcomes of introducing SDM and an in-consultation Patient Decision Aid (PtDA) in the initial process of lung cancer diagnostics.

We conducted a prospective cohort study, where a control cohort was consulted according to usual clinical practice. After introducing SDM through a PtDA and training of the staff, the SDM cohort was enrolled in the study. All patients completed four questionnaires: the Decisional Conflict Scale (DCS) before and after the consultation, the CollaboRATE scale after the consultation, and the Decision Regret Scale (DRS) six months after the consultation.

Patients exposed to SDM and a PtDA had significantly improved DCS scores after the consultation compared to the control group (a difference of 10.26, p = 0.0128) and significantly lower DRS scores (a difference of 8.98, p = 0.0197). Of the 82 control patients and 52 SDM patients 29% and 54%, respectively, reported maximum score on the CollaboRATE scale (Pearson’s chi2 8.0946, p = 0.004).

The use of SDM and a PtDA had significant positive impact on patient-reported outcomes. This may encourage the increased uptake of SDM in the initial process of lung cancer diagnostics.
Publikationsdato10. jul. 2019
StatusUdgivet - 10. jul. 2019
Begivenhed10th International Shared Decision Making Conference (ISDM 2019) - Laval University, Quebec, Danmark
Varighed: 7. jul. 201910. jul. 2019


Konference10th International Shared Decision Making Conference (ISDM 2019)
LokationLaval University

Bibliografisk note

Oral presentation (abstract)