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Showing content from https://pubmed.ncbi.nlm.nih.gov/32798520/ below:

How Health-Care Organizations Implement Shared Decision-making When It Is Required for Reimbursement: The Case of Lung Cancer Screening

. 2021 Jan;159(1):413-425. doi: 10.1016/j.chest.2020.07.078. Epub 2020 Aug 13. How Health-Care Organizations Implement Shared Decision-making When It Is Required for Reimbursement: The Case of Lung Cancer Screening

Affiliations

¹ Eshelman School of Pharmacy, Chapel Hill, NC.
² Henry Ford Health System, Detroit, MI.
³ University of South Florida College of Medicine, Tampa, FL; Moffitt Cancer Center, Tampa, FL.
⁴ School of Medicine, University of North Carolina, Chapel Hill, NC; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC.
⁵ Eshelman School of Pharmacy, Chapel Hill, NC; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Henry Ford Health System, Detroit, MI. Electronic address: jel@email.unc.edu.

PMID: 32798520
PMCID: PMC7893305
DOI: 10.1016/j.chest.2020.07.078

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How Health-Care Organizations Implement Shared Decision-making When It Is Required for Reimbursement: The Case of Lung Cancer Screening

Amir Alishahi Tabriz et al. Chest. 2021 Jan.

. 2021 Jan;159(1):413-425. doi: 10.1016/j.chest.2020.07.078. Epub 2020 Aug 13. Affiliations

¹ Eshelman School of Pharmacy, Chapel Hill, NC.
² Henry Ford Health System, Detroit, MI.
³ University of South Florida College of Medicine, Tampa, FL; Moffitt Cancer Center, Tampa, FL.
⁴ School of Medicine, University of North Carolina, Chapel Hill, NC; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC.
⁵ Eshelman School of Pharmacy, Chapel Hill, NC; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Henry Ford Health System, Detroit, MI. Electronic address: jel@email.unc.edu.

PMID: 32798520
PMCID: PMC7893305
DOI: 10.1016/j.chest.2020.07.078

Item in Clipboard

Abstract

Background: The Centers for Medicare and Medicaid Services stipulate shared decision-making (SDM) counseling as a prerequisite to lung cancer screening (LCS) reimbursement, despite well-known challenges implementing SDM in practice.

Research question: How have health-care organizations implemented SDM for LCS?

Study design and methods: For this qualitative study, we used data from in-depth, semistructured interviews with key informants directly involved in implementing SDM for LCS, managing SDM for LCS, or both. We identified respondents using a snowball sampling technique and used template analysis to identify and analyze responses thematically.

Results: We interviewed 30 informants representing 23 health-care organizations located in 12 states and 4 Census regions. Respondents described two types of SDM for LCS programs: centralized models (n = 7), in which front-end practitioners (eg, primary care providers) referred patients to an LCS clinic where trained staff (eg, advanced practice nurses) delivered SDM at the time of screening, or decentralized models (n = 10), in which front-end practitioners delivered SDM before referring patients for screening. Some organizations used both models simultaneously (n = 6). Respondents discussed tradeoffs between SDM quality and access. They perceived centralized models as enhancing SDM quality, but limiting patient access to care, and vice versa. Respondents reported ongoing challenges with limited resources and budgetary constraints, ambiguity regarding what constitutes SDM, and an absence of benchmarks for evaluating SDM for LCS quality.

Interpretation: Those responsible for developing and managing SDM for LCS programs voiced concerns regarding both patient access and SDM quality, regardless of organizational context, or the SDM for LCS model implemented. The challenge facing these organizations, and those wanting to help patients and clinicians balance the tradeoffs inherent with LCS, is how to move beyond a check-box documentation requirement to a process that enables LCS to be offered to all high-risk patients, but used only by those who are informed and for whom screening represents a value-concordant service.

Keywords: implementation; informed decision-making; lung cancer; lung cancer screening; shared decision-making.

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Figures
Figure 1

Diagram summarizing shared decision-making for…

Figure 1

Diagram summarizing shared decision-making for lung cancer screening program models.

Figure 1

Diagram summarizing shared decision-making for lung cancer screening program models.