Patient Perceptions of Quality of Shared Decision-Making for Lung Cancer Screening in Telehealth versus In-Person Discussions.

Abstract

Guidelines recommend shared decision-making (SDM) about lung cancer screening (LCS) to ensure choices about LCS are informed and consistent with patient goals. Telehealth may increase access to SDM, but its quality compared to in-person delivery remains unclear. How does modality (in-person or telehealth) affect patients' perceptions of quality of SDM for LCS, associated best practices, and outcomes? We administered a mail survey to patients from 7 Veterans Affairs hospitals who underwent SDM for LCS within the prior month. Surveys assessed demographics, SDM modality (primary exposure), occurrence of best practices for LCS counseling and SDM (provision of educational materials, alignment with decision-making preferences, smoking cessation counseling), and decision-making outcomes (perceived quality, provider empathy, satisfaction, LCS decisions). Adherence to initial LCS scan was determined from the Corporate Data Warehouse. Our primary outcome was perceived SDM quality measured using the CollaboRATE score (top-score of 27 indicates high quality). Of 1033 patients surveyed, 320 responded (31.0%); 121 were excluded due to not remembering the LCS conversation or missing primary exposure or outcome data. LCS conversations were evenly split between in-person (101/199) and telehealth (98/199). Overall, 34.2% (68/199) reported high-quality SDM, with no significant difference by modality (adjusted OR=0.76, 95% CI [0.398-1.448] for telehealth vs in-person). Educational materials were supplied significantly more often during in-person than telehealth discussions (40.6% vs 22.6% p=.008). Comparing in-person to telehealth, we found no significant difference in secondary outcomes including decision satisfaction, perceived provider empathy, alignment of decision-making with the patient's preferred style, provision of smoking cessation counseling to those currently smoking, LCS decisions, or adherence to initial LCS scan. Outcomes were similar regardless of modality of LCS SDM conversations. Telehealth for LCS SDM may be a useful option to improve equity and access, potentially reducing barriers to LCS uptake.