When Is a Harm a Harm? Discordance between Patient and Medical Experts’ Evaluation of Lung Cancer Screening Attributes

Marilyn M. Schapira, Keri L. Rodriguez, Sumedha Chhatre, Liana Fraenkel, Lori A. Bastian, Jeffrey D. Kravetz, Onur Asan, Scott Akers, Anil Vachani, Jason M. Prigge, Jessica Meline, Jennifer V. Ibarra, Barbara Corn and Dana Kaminstein
Additional contact information
Marilyn M. Schapira: The Center for Health Equity Research and Promotion (CHERP) at the Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia, PA, USA
Keri L. Rodriguez: CHERP, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
Sumedha Chhatre: The Center for Health Equity Research and Promotion (CHERP) at the Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia, PA, USA
Liana Fraenkel: VA Connecticut Healthcare System, West Haven, CT, USA
Lori A. Bastian: VA Connecticut Healthcare System, West Haven, CT, USA
Jeffrey D. Kravetz: VA Connecticut Healthcare System, West Haven, CT, USA
Onur Asan: The Stevens Institute of Technology, School of Systems and Enterprises, Hoboken, NJ, USA
Scott Akers: Department of Radiology, The Michael J. Crescenz VA Medical Center and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
Anil Vachani: The Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
Jason M. Prigge: The Center for Health Equity Research and Promotion (CHERP) at the Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia, PA, USA
Jessica Meline: The Center for Health Equity Research and Promotion (CHERP) at the Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia, PA, USA
Jennifer V. Ibarra: VA Connecticut Healthcare System, West Haven, CT, USA
Barbara Corn: VA Connecticut Healthcare System, West Haven, CT, USA
Dana Kaminstein: The Center for Health Equity Research and Promotion (CHERP) at the Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia, PA, USA

Medical Decision Making, 2021, vol. 41, issue 3, 317-328

Abstract: Background A shared decision-making (SDM) process for lung cancer screening (LCS) includes a discussion between clinicians and patients about benefits and potential harms. Expert-driven taxonomies consider mortality reduction a benefit and consider false-positives, incidental findings, overdiagnosis, overtreatment, radiation exposure, and direct and indirect costs of LCS as potential harms. Objective To explore whether patients conceptualize the attributes of LCS differently from expert-driven taxonomies. Design Cross-sectional study with semistructured interviews and a card-sort activity. Participants Twenty-three Veterans receiving primary care at a Veterans Affairs Medical Center, 55 to 73 y of age with 30 or more pack-years of smoking. Sixty-one percent were non-Hispanic African American or Black, 35% were non-Hispanic White, 4% were Hispanic, and 9% were female. Approach Semistructured interviews with thematic coding. Main Measures The proportion of participants categorizing each attribute as a benefit or harm and emergent themes that informed this categorization. Key Results In addition to categorizing reduced lung cancer deaths as a benefit (22/23), most also categorized the following as benefits: routine annual screening (8/9), significant incidental findings (20/23), follow-up in a nodule clinic (20/23), and invasive procedures (16/23). Four attributes were classified by most participants as a harm: false-positive (13/22), overdiagnosis (13/23), overtreatment (6/9), and radiation exposure (20/22). Themes regarding the evaluation of LCS outcomes were 1) the value of knowledge about body and health, 2) anticipated positive and negative emotions, 3) lack of clarity in terminology, 4) underlying beliefs about cancer, and 5) risk assessment and tolerance for uncertainty. Conclusions Anticipating discordance between patient- and expert-driven taxonomies of the benefits and harms of LCS can inform the development and interpretation of value elicitation and SDM discussions.

Keywords: card-sort activity; lung cancer screening; patient values; shared decision making; value elicitation (search for similar items in EconPapers)
Date: 2021
References: View references in EconPapers View complete reference list from CitEc
Citations:

Downloads: (external link)
https://journals.sagepub.com/doi/10.1177/0272989X20987221 (text/html)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:41:y:2021:i:3:p:317-328

DOI: 10.1177/0272989X20987221

Access Statistics for this article

More articles in Medical Decision Making
Bibliographic data for series maintained by SAGE Publications ().