Association of Shared Decision-Making With Long-Term Adherence to Lung Cancer Screening.

Abstract

Lung cancer screening (LCS) by low-dose CT imaging reduces lung cancer mortality and is covered by Medicare, yet adherence to screening for eligible Medicare beneficiaries is low. Medicare requires a shared decision-making (SDM) visit before the initial LCS, with a stated goal of promoting adherence to annual screening, but it is unknown whether these visits improve adherence over time. Is an SDM visit before initial LCS associated with improved screening adherence among Medicare beneficiaries over time? This retrospective cohort study used Medicare fee-for-service claims data to identify beneficiaries who underwent the first LCS between 2016 and 2019. Screened beneficiaries who had a SDM visit claim within 90 days before the initial LCS were compared with the cohort with no SDM visit. Using linear probability models, we estimated differences in the annual screening rate between these 2 groups for 1 to 4 years after the initial screening, controlling for patient and clinician characteristics. Among 22,670 screened beneficiaries, 11.4% underwent an SDM visit. Patients with and without an SDM visit were similar, except for geographical location. The SDM group showed an adherence rate that was 26.5% higher than the non-SDM group in the 1 year after the first LCS. The effect was persistent, and the difference grew to 32.5% higher in the 4 years after the first LCS. Undergoing an SDM visit was associated with significantly higher LCS adherence for 4 years after the initial screening, supporting SDM as a strategy to increase LCS adherence.