Associations of Concordant and Shared Lung Cancer Screening Decision Making with Decisional Conflict: A Multi-Institution Cross-Sectional Analysis
Introduction. Many organizations recommend structured communication processes, including formal shared decision making (SDM), for patients undergoing lung cancer screening (LCS) using low-dose computed tomography (LDCT). We sought to understand if concordant and shared LCS decision making was associ...
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2025-01-01
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| Series: | MDM Policy & Practice |
| Online Access: | https://doi.org/10.1177/23814683241309945 |
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| author | Donald R. Sullivan Sara E. Golden Liana Schweiger Anne C. Melzer Santanu Datta James M. Davis Renda Soylemez Wiener Christopher G. Slatore |
| author_facet | Donald R. Sullivan Sara E. Golden Liana Schweiger Anne C. Melzer Santanu Datta James M. Davis Renda Soylemez Wiener Christopher G. Slatore |
| author_sort | Donald R. Sullivan |
| collection | DOAJ |
| description | Introduction. Many organizations recommend structured communication processes, including formal shared decision making (SDM), for patients undergoing lung cancer screening (LCS) using low-dose computed tomography (LDCT). We sought to understand if concordant and shared LCS decision making was associated with decisional conflict. Methods. In this prospective, observational study, we enrolled patients from 3 medical centers (2 Veterans Health Administration, 1 academic facility) after a decision-making interaction about undergoing LCS but before receiving the LDCT. We included patients who indicated they accepted or declined to undergo the LDCT. We evaluated preferred and actual decision-making roles and used multivariable linear and logistic regression models to measure the association of concordant (congruence between actual and preferred roles) and shared LCS decision making with decisional conflict to report adjusted odds ratios (AOR). Results. Of the 409 participants with nonmissing information, 83% reported LCS decision-making role concordance. In addition, 223 (58%) reported an indeterminate level and 56 (14%) reported decisional conflict. LCS decision-making role concordance was not associated with decisional conflict (AOR = 0.86, 95% confidence interval [CI]: 0.38–1.94, P = 0.71) compared with role discordance. Participant-reported actual LCS SDM role was not associated with decisional conflict (AOR = 0.99, 95% CI: 0.51–1.93, P = 0.98) compared with patient- or provider-controlled roles. Conclusions. LCS decisional conflict was uncommon, although many patients reported an indeterminate level of decisional conflict. Neither concordant nor shared LCS decision-making role was associated with decisional conflict. Clinicians may be unable to decrease LCS decisional conflict using efforts to enhance decision-making interactions. Highlights We evaluated patients’ preferred and actual decision-making role and decisional conflict following a decision-making interaction about lung cancer screening (LCS). Concordant decision-making preference was not associated with decisional conflict. Actual decision-making role was also not associated with decisional conflict. Efforts to enhance decision-making interactions may not decrease LCS decisional conflict. |
| format | Article |
| id | doaj-art-fa4a7d9f0b324b17bacf23b8cec26f35 |
| institution | Kabale University |
| issn | 2381-4683 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | MDM Policy & Practice |
| spelling | doaj-art-fa4a7d9f0b324b17bacf23b8cec26f352025-01-17T11:03:20ZengSAGE PublishingMDM Policy & Practice2381-46832025-01-011010.1177/23814683241309945Associations of Concordant and Shared Lung Cancer Screening Decision Making with Decisional Conflict: A Multi-Institution Cross-Sectional AnalysisDonald R. SullivanSara E. GoldenLiana SchweigerAnne C. MelzerSantanu DattaJames M. DavisRenda Soylemez WienerChristopher G. SlatoreIntroduction. Many organizations recommend structured communication processes, including formal shared decision making (SDM), for patients undergoing lung cancer screening (LCS) using low-dose computed tomography (LDCT). We sought to understand if concordant and shared LCS decision making was associated with decisional conflict. Methods. In this prospective, observational study, we enrolled patients from 3 medical centers (2 Veterans Health Administration, 1 academic facility) after a decision-making interaction about undergoing LCS but before receiving the LDCT. We included patients who indicated they accepted or declined to undergo the LDCT. We evaluated preferred and actual decision-making roles and used multivariable linear and logistic regression models to measure the association of concordant (congruence between actual and preferred roles) and shared LCS decision making with decisional conflict to report adjusted odds ratios (AOR). Results. Of the 409 participants with nonmissing information, 83% reported LCS decision-making role concordance. In addition, 223 (58%) reported an indeterminate level and 56 (14%) reported decisional conflict. LCS decision-making role concordance was not associated with decisional conflict (AOR = 0.86, 95% confidence interval [CI]: 0.38–1.94, P = 0.71) compared with role discordance. Participant-reported actual LCS SDM role was not associated with decisional conflict (AOR = 0.99, 95% CI: 0.51–1.93, P = 0.98) compared with patient- or provider-controlled roles. Conclusions. LCS decisional conflict was uncommon, although many patients reported an indeterminate level of decisional conflict. Neither concordant nor shared LCS decision-making role was associated with decisional conflict. Clinicians may be unable to decrease LCS decisional conflict using efforts to enhance decision-making interactions. Highlights We evaluated patients’ preferred and actual decision-making role and decisional conflict following a decision-making interaction about lung cancer screening (LCS). Concordant decision-making preference was not associated with decisional conflict. Actual decision-making role was also not associated with decisional conflict. Efforts to enhance decision-making interactions may not decrease LCS decisional conflict.https://doi.org/10.1177/23814683241309945 |
| spellingShingle | Donald R. Sullivan Sara E. Golden Liana Schweiger Anne C. Melzer Santanu Datta James M. Davis Renda Soylemez Wiener Christopher G. Slatore Associations of Concordant and Shared Lung Cancer Screening Decision Making with Decisional Conflict: A Multi-Institution Cross-Sectional Analysis MDM Policy & Practice |
| title | Associations of Concordant and Shared Lung Cancer Screening Decision Making with Decisional Conflict: A Multi-Institution Cross-Sectional Analysis |
| title_full | Associations of Concordant and Shared Lung Cancer Screening Decision Making with Decisional Conflict: A Multi-Institution Cross-Sectional Analysis |
| title_fullStr | Associations of Concordant and Shared Lung Cancer Screening Decision Making with Decisional Conflict: A Multi-Institution Cross-Sectional Analysis |
| title_full_unstemmed | Associations of Concordant and Shared Lung Cancer Screening Decision Making with Decisional Conflict: A Multi-Institution Cross-Sectional Analysis |
| title_short | Associations of Concordant and Shared Lung Cancer Screening Decision Making with Decisional Conflict: A Multi-Institution Cross-Sectional Analysis |
| title_sort | associations of concordant and shared lung cancer screening decision making with decisional conflict a multi institution cross sectional analysis |
| url | https://doi.org/10.1177/23814683241309945 |
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