Navigating shared decision-making in lung cancer screening: Insights into barriers, training, and referral propensity among clinicians.

Abstract

Shared decision-making (SDM) is critical in lung cancer screening (LCS), enabling clinicians to guide patients through complex benefit-risk discussions. Despite its endorsement by professional organizations and its Medicare reimbursement requirement, SDM implementation in clinical practice remains inconsistent. This cross-sectional study evaluated factors influencing clinician knowledge, attitudes, and referral behaviors regarding LCS within a decentralized screening program. We surveyed 125 primary care clinicians (PCCs) in a large integrated health system, linking responses to electronic health record data to assess LCS referral propensity. Clinicians reported perceived barriers to SDM, attitudes toward SDM and LCS, and knowledge via clinical vignettes. Multivariable analyses identified key predictors of attitudes and behaviors. Findings revealed that perceived barriers to SDM, particularly time burden, significantly influenced attitudes toward LCS (β = -0.334, p < 0.001) and referral propensity (β = -0.305, p = 0.0005). Formal training in SDM for LCS was positively associated with favorable SDM attitudes (β = 0.035, p = 0.0248), emphasizing the potential of targeted interventions. Time burden emerged as a critical determinant of perceived barriers (β = 0.728, p < 0.001), highlighting the need for systemic and educational solutions. These results underscore the importance of reducing SDM-related time burdens and enhancing training to improve clinician engagement and screening outcomes. Innovative strategies, such as patient-tailored pre-visit education and team-based care models, could mitigate barriers and promote more effective SDM implementation. Future research should explore longitudinal and multi-system analyses to refine interventions and optimize LCS processes. By addressing systemic and individual barriers, health systems can enhance SDM efficacy, increasing LCS uptake and improving care for screening-eligible populations. This study offers actionable insights for advancing patient-centered approaches in LCS and broader preventive health initiatives.