Quality of Shared Decision Making in Lung Cancer Screening: The Right Process, With the Right Partners, at the Right Time and Place

[...]patient preferences are constructed in the process of evaluating the options of screening or not screening and may evolve as patients receive information and are involved in SDM. [...]preferences may change as patients move across settings and access new information. To ensure a high-quality SDM service, however, SDM for lung cancer screening must transcend the use of tools and instead broadly meet the six domains of health care quality put forward by the Institute of Medicine: SDM should be safe, effective, patient centered, timely, efficient, and equitable.5 Delegating SDM to clinicians who are not directly involved in lung cancer screening could mitigate conflicts of interest and associated proscreening biases. In our experience, however, clinicians who believe that a patient will benefit from an intervention can use these same tools to persuade a patient of its value.6 Because the magnitude of specialist bias (and of potential anti-screening bias among primary care clinicians) and its effect on the uptake of LDCT for lung cancer screening remains unknown, improvements in the quality of SDM will need to be based on evidence about the limitations of existing services and of the referral paths used to access them. The implementation of SDM to determine with patients how to address the problem of elevated risk of lung cancer-including methods of smoking cessation and lung cancer screening-would benefit from quality evaluation.