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

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  • 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
    Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA)

  • Keri L. Rodriguez

    (CHERP, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
    Department of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, 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
    The Department of Psychiatry, the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA)

  • Liana Fraenkel

    (VA Connecticut Healthcare System, West Haven, CT, USA
    Yale University School of Medicine, New Haven, CT, USA)

  • Lori A. Bastian

    (VA Connecticut Healthcare System, West Haven, CT, USA
    Yale University School of Medicine, New Haven, CT, USA)

  • Jeffrey D. Kravetz

    (VA Connecticut Healthcare System, West Haven, CT, USA
    Yale University School of Medicine, New 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
    Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, 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
    Organizational Dynamics, Liberal and Professional Studies, School of Arts & Sciences, University of Pennsylvania, Philadelphia, PA, USA)

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.

Suggested Citation

  • 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, 2021. "When Is a Harm a Harm? Discordance between Patient and Medical Experts’ Evaluation of Lung Cancer Screening Attributes," Medical Decision Making, , vol. 41(3), pages 317-328, April.
    • Handle: RePEc:sae:medema:v:41:y:2021:i:3:p:317-328
    DOI: 10.1177/0272989X20987221
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    References listed on IDEAS

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