July 9, 2025
Doctor-led Shared Decision-Making Significantly Boosts Lung Cancer Screening Adherence Over Time
Shared Decision-Making Improves Adherence to LCS Guidelines
A new study published in CHEST finds that Medicare beneficiaries who participated in a shared decision-making (SDM) visit with their healthcare provider prior to their initial lung cancer screening (LCS) were significantly more likely to adhere to recommended annual follow-up screenings over a four-year period.
The findings suggest that this discussion may be an effective strategy to improve adherence in lung cancer screening programs and reduce lung cancer mortality through earlier detection using low dose computed tomography (LDCT).
“Lung cancer screening for current and prior smokers with a 20 pack-year history has been shown to significantly reduce related deaths,” said author Ruth Carlos, MD, professor of radiology at the Columbia University Vagelos College of Physicians and Surgeons. “Routine shared decision making can serve as educational encounters to align screening services with patient preference.”
Researchers from the Harvey L. Neiman Health Policy Institute (HPI) conducted a retrospective cohort study using a nationally representative 5% sample of Medicare fee-for-service beneficiaries’ data from 2015 to 2020. Among 22,670 beneficiaries who received their first LDCT scan between 2016 and 2019, only 11.4% had a documented SDM visit within 90 days prior to screening. Yet those with an SDM visit had subsequent adherence rates that were 21.1% to 32.5% higher than those without, across four years of follow-up.
“We found that patients who had a shared decision-making visit with their provider were more likely to remain engaged with lung cancer screening over time,” said lead author YoonKyung Chung, PhD, Principal Researcher at the Neiman HPI. “This effect was consistent even after adjusting for patient, clinician, and practice-level factors.”
Annual adherence to LCS is essential for detecting lung cancer in early stages, when it is most treatable. However, previous studies have documented alarmingly low adherence rates. The largest study to date by Silvestri et al. found just 22.3% repeated screening after one year and less than 5.9% by year three. The Neiman Institute researchers found that 34.8% of patients returned for screening one year after their initial LDCT, dropping to 23.8% by the fourth year.
Next, the research team compared patients with versus without a SDM visit, using matching and statistical controls to ensure an apples-to-apples comparison. They found that the LDCT adherence rate for patients who had an SDM visit was 26.5% higher the first year after their initial screening and continued to be significantly higher in all four follow-up years compared to patients without an SDM visit. By the fourth year of follow up, the SDM group achieved 32.5% higher adherence than their counterparts.
“Our findings provide strong evidence supporting SDM, which was associated with a meaningful and lasting impact on screening behavior,” said Eric Christensen, PhD, Research Director at the Neiman HPI and study senior author. “Policies and practice-level interventions aimed at increasing LCS adherence should leverage these findings to expand SDM use, especially as CMS continues to evolve its LCS guidelines, and now specifically reimburses providers for having these discussions.”
Although SDM is required by Medicare for LCS referral, the uptake of SDM remains low. The study found SDM rates plateaued at just over 12.1% during the study period, echoing findings from previous studies. The researchers point to several possible barriers, including unclear enforcement of SDM requirements and time constraints in clinical workflows.
“Shared decision-making is more than just a billing requirement—it’s a valuable opportunity to engage patients in informed, personalized discussions about screening. There is an opportunity to leverage this new evidence in national campaigns to raise awareness of lung screening and the importance of prioritizing SDM in routine clinical care to improve early detection and outcomes for one of the deadliest forms of cancer,” noted author Farouk Dako, Associate Professor of Radiology, Perelman School of Medicine.