“I'm Putting My Trust in Their Hands”: A Qualitative Study of Patients’ Views on Clinician Initial Communication About Lung Cancer Screening

Background: Lung cancer screening (LCS) using low-dose CT imaging is recommended for people at high risk of dying of lung cancer. Communication strategies for clinicians have been recommended, but their influence on patient-centered outcomes is unclear. Research Question: How do patients experience communication and decision-making with clinicians when offered LCS? Study Design and Methods: We performed semistructured interviews with 51 patients from three institutions with established LCS programs. We focused on communication domains such as information exchange, patient as person, and shared decision-making. Using conventional content analysis, we report on patients’ assessment of information, reasons for (dis)satisfaction, distress, and role in the decision-making process. Results: Participants recalled few specific harms or benefits of screening, but uniformly reported satisfaction with the amount of information provided. All participants reported that clinicians did not explicitly ask about their values and preferences and about one-half reported some distress in anticipation of screening results. Almost all participants were satisfied with their role in the decision-making process. Despite participants’ reporting that they did not experience all aspect of shared decision-making as defined, they reported high levels of trust in clinicians, which may relate to their largely positive reactions to the LCS decision interaction through the patient as person domain of communication. Interpretation: Although decision-making for lung cancer screening as currently practiced may not meet all criteria of high-quality communication, patients in our sample are satisfied with the process, and report high trust in clinicians. Patients may place greater importance on interpersonal aspects of communication rather than information exchange.