Longitudinal Assessment of Communication With Patient-Reported Outcomes During Lung Cancer Screening

Background: Many organizations recommend clinicians use structured communication processes, referred to as shared decision-making, to improve patient-reported outcomes for patients considering lung cancer screening (LCS). Research Question: Which components of high-quality patient-centered communication are associated with decision regret and distress? Study Design and Methods: We conducted a prospective, longitudinal, repeated measures cohort study among patients undergoing LCS in three different health care systems. We surveyed participants using validated measures of decision regret, decision satisfaction, distress, and patient-clinician communication domains up to 1 year after the low-dose CT (LDCT) imaging for LCS. For longitudinal analyses, we applied a series of generalized estimating equations to measure the association of the patient as person communication domain, screening knowledge, and decision concordance with decision regret and distress. Results: When assessed 2 to 4 weeks after the LDCT imaging, 202 respondents (58.9%) and eight respondents (2.3%) of 343 total respondents reported mild and moderate or severe decision regret, respectively, whereas 29 respondents (9.2%) of 315 total respondents reported mild distress and 19 respondents (6.0%) reported moderate or greater distress. The mean ± SD decision satisfaction scores (scale, 0-10) were 9.82 ± 0.89, 9.08 ± 1.54, and 6.13 ± 3.40 among those with no, mild, and moderate or severe regret, respectively. Distress scores remained low after the LDCT imaging, even among those with nodules. Patient-centered communication domains were not associated with decision regret or distress. Interpretation: Our findings show that patients undergoing LCS rarely experience moderate or greater decision regret and distress. Although many participants reported mild decision regret, most were very satisfied over the 1 year after LDCT imaging for LCS. Communication processes were not associated with regret and distress, suggesting that it may be challenging for communication interventions to reduce the harms of LCS.