The Importance of Shared Decision Making in Lung Cancer Screening

by Mary C Politi, PhD and Sydney Philpott

More people in the United States die from lung cancer than any other type of cancer. Patients and providers want and need ways to find lung cancer early when it is more easily treated. Recently, the Centers for Medicare and Medicaid Services (CMS) approved yearly lung cancer screening through low-dose CT (LDCT) scans as one possible way to find lung cancer early. Screening can save lives among people who are at high risk for developing lung cancer. However, the decision to get yearly lung cancer screening is not as clear-cut as it sounds.

CMS requires counseling through a process called shared decision making to help patients decide whether yearly lung cancer screening with LDCT is right for them. Shared decision making is a process through which patients and their providers make health care decisions together. It helps patients learn the scientific evidence about options, think about the pros and cons of options, and encourages them to consider what is important to them so they can make an informed, personal choice. Decision aids that present information in a balanced way can be used to add to conversations patients have with their providers about health choices.

To think about yearly lung cancer screening with LDCT, first patients need to learn whether they are eligible and likely to benefit from screening. Patients who are 55-80 years old and have a smoking history of 30 pack years or more (click here to calculate your smoking history in pack years) are eligible to be screened. Next, patients need to weigh the pros and cons of screening.

Screening through yearly LDCT can find lung cancer earlier than waiting until a patient has symptoms. But it can also find “false alarms,” or abnormalities that look concerning but might not be cancer. These false alarms could lead to unnecessary tests or biopsies. Several of us at Washington University and Siteman Cancer Center have developed a tool to help patients think about whether yearly lung cancer screening through LDCT is right for them.

If patients smoke, quitting smoking is a core part of the conversation about lung cancer screening. Quitting smoking lowers the risk of getting lung cancer and other diseases of the lungs, heart, blood, and brain. Smokers can get a free “quit plan” online or contact the Smoking Cessation Program at Washington University (314-362-7844) for help quitting.

Shared decision making is an important part of making medical decisions. Engaging in this process can help patients feel more informed and confident in their health choices. When thinking about lung cancer screening, requiring shared decision making helps patients and providers talk about screening in a collaborative way and truly puts patients’ values at the forefront of medical decisions.


“Lung Cancer Statistics.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 20 Aug. 2015. Web. 7 Oct. 2015.

“What Is Shared Decision Making?” Informed Medical Decisions Foundation. Web. 7 Oct. 2015.

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