AHRQ Views: Blog posts from AHRQ leaders
New Decision Aids Support Shared Decisionmaking for Lung Cancer Screening
By Richard Ricciardi, Ph.D., N.P., Senior Nursing Advisor for AHRQ, and Monique D. Cohen, Ph.D., M.P.H., Health Scientist Administrator, AHRQ Center for Evidence and Practice Improvement
While smoking rates continue to decline, tobacco remains among the nation’s most pernicious health threats. About 17 percent of adults—40 million Americans—are smokers, according to Federal estimates. Each year, 150,000 people die from lung cancer.
For some adults, annual lung cancer screening could lead to an early diagnosis and life-saving treatment. The decision can be difficult, however; lung cancer screening carries potential harms as well as benefits. Helping to navigate these complexities is why AHRQ developed a new suite of tools to assist clinicians and patients make informed decisions about lung cancer screening.
AHRQ's tools are aimed at a specific audience—adults aged 55 to 80 years who have smoked the equivalent of one pack a day for at least 30 years and who continue to smoke or who have quit less than 15 years ago. These decision aids are based in part upon U.S. Preventive Services Task Force recommendations, which were developed through a systematic review and consideration of current evidence for lung cancer screening.
AHRQ's new tools help simplify conversations and decisionmaking among patients and primary care clinicians about low-dose computed tomography (LDCT), the only endorsed screening strategy for lung cancer:
- For patients: Is Lung Cancer Screening Right for Me? A Decision Aid for People Considering Lung Cancer Screening With Low-Dose Computed Tomography.
- For patients and their health care professionals: Is Lung Cancer Screening Right for Me? A Decisionmaking Tool for You and Your Health Care Professional.
- For primary care clinicians: Lung Cancer Screening: A Summary Guide for Primary Care Clinicians and Lung Cancer Screening: A Clinician’s Checklist.
Patients can use these tools effectively to learn the facts about lung cancer, compare the benefits and harms of screening with LDCT, evaluate how their own values relate to screening, and learn about insurance coverage.
Primary care teams, including physicians, physician assistants, nurse practitioners, and clinical nurse specialists, may use the summary guide and checklist to help them meet the Centers for Medicare & Medicaid Services criteria for lung cancer screening counseling and shared decisionmaking. In addition, registered nurses working on primary care teams are well positioned to help educate patients about lung cancer screening and facilitate the patient’s use of AHRQ's decisionmaking tools.
The tools provide important context for clinician-patient interactions. Patients should understand, for example, that screening is not a substitute for quitting smoking; the most important way to lower the chance of dying from lung cancer is to stop smoking. The tools also emphasize that screening is a process; an abnormal LDCT scan does not necessarily mean cancer but may call for additional testing to determine a diagnosis. In addition, while screening may carry risks (such as false positives, which can lead to unneeded treatment), LDCT, through early detection of cancer, may help avoid diagnosis at an advanced stage when treatment is much less effective. About 9 out of every 10 people with lung cancer die from the disease because it is found after it has spread.
AHRQ's lung cancer screening tools add to the suite of decision aids from AHRQ's Effective Health Care Program. Previously developed tools are available to help clinicians and patients work together to make informed treatment decisions about urinary incontinence in women, osteoporosis in post-menopausal women, and localized prostate cancer in men.
With this inventory of products, AHRQ underscores its ongoing commitment to evidence and meaningful collaborations between patients and their health care team of physicians, nurses, and physician assistants. It's a combination that increases the odds for better care—and, in some cases, can save a life.