Prospective Multisite Cohort Study to Evaluate Shared Decision-Making Utilization Among Individuals Screened for Lung Cancer.
Prospective Multisite Cohort Study to Evaluate Shared Decision-Making Utilization Among Individuals Screened for Lung Cancer.
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DOI：
10.1016/j.jacr.2022.03.005
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发表时间：
2022-08
影响因子：
4.5
通讯作者：
Henderson, Louise M
中科院分区：
文献类型：
--
作者：
Tailor, Tina D;Rivera, M Patricia;Durham, Danielle D;Perera, Pasangi;Lane, Lindsay;Henderson, Louise M
根据接受肺癌筛查(LCS)的个人的电子健康记录(EHR)文件，确定共享决策(SDM)讨论的频率、组成部分和相关因素。对2015年2月至2020年6月期间在四个LCS中心接受LCS的个人进行前瞻性观察队列研究。主要结果是EHR记录的SDM，使用Medicare指定的组件定义。使用多变量Logistic回归模型来检验EHR记录的SDM的预测因素。次要结果是个体对SDM的自我报告与EHR记录的SDM的一致性，使用Cohen的kappa统计量进行评估。在筛查的个体中，41.9%(243/580)有EHR记录的SDM，71.1%(295/415)有自我报告的SDM。在55.6%(135/243)的EHR记录的SDM接触中使用了决策辅助，21.8%(53/243)记录的SDM接触包括所有医疗保险指定的组件。体重指数(≥)为25和25的个体(调整后的优势比=1.63，95%可信区间(95%CI)：1.05-2.52)和现在吸烟的个体(调整后的优势比=1.53，95%可信区间：1.02-2.32)更常被记录在案。非肺科转诊医生比肺科转诊医生更少记录SDM(内科：AOR=0.32，95%CI：0.18~0.53；全科：AOR=0.08，95%CI：0.04~0.14；其他专科：AOR=0.08，95%CI：0.03~0.21)。在415人的子集中，个体自我报告的SDM和EHR记录的SDM之间几乎没有一致性(kappa=0.184)，一致性的差异基于参考临床医生的专业。虽然在接受LCS的患者中，不到一半的人发生了EHR记录的SDM，但自我报告的SDM发生率更高，这表明SDM可能在EHR中记录不足。此外，EHR记录的SDM更有可能发生在BMI较高的个体和肺部临床医生推荐的LCS患者中。这些调查结果表明，在可持续发展管理的实施和记录方面需要改进的领域。在肺癌筛查的个体中，SDM记录的差异强调了促进高质量SDM使用和改进记录的干预的必要性。
To determine the frequency, components of, and factors associated with shared decision making (SDM) discussions according to electronic health record (EHR) documentation among individuals receiving lung cancer screening (LCS). Prospective observational cohort study of individuals undergoing LCS between February 2015 and June 2020 at four LCS centers. The primary outcome was EHR-documented SDM, defined using Medicare-designated components. A multivariable logistic regression model was used to examine predictors of EHR-documented SDM. A secondary outcome was agreement of individual’s self-report of SDM and EHR documented SDM evaluated using Cohen’s kappa statistic. Among screened individuals, 41.9% (243/580) had EHR-documented SDM, and 71.1% (295/415) had self-reported SDM. Decision aids were used in 55.6% (135/243) of EHR-documented SDM encounters, and 21.8% (53/243) of documented SDM encounters included all Medicare-designated components. SDM was documented more frequently in individuals with body mass index (BMI) ≥25 versus <25 (adjusted odds ratio (aOR)=1.63, 95% confidence interval (95%CI):1.05-2.52), and in currently versus formerly smoking individuals (aOR=1.53, 95%CI:1.02-2.32). Non-pulmonary referring clinicians were less likely to document SDM than pulmonary clinicians (internal medicine: aOR=0.32, 95%CI:0.18-0.53, family medicine: aOR=0.08, 95%CI:0.04-0.14, other specialties: aOR=0.08, 95%CI:0.03-0.21). In a subset of 415 individuals, there was little agreement between individual self-report of SDM and EHR-documented SDM (kappa=0.184), with variation in agreement based on referring clinician specialty. While EHR-documented SDM occurred in less than half of individuals receiving LCS, self-reported SDM rates were higher, suggesting SDM may be under-documented in the EHR. In addition, EHR-documented SDM was more likely in individuals with higher BMI and those referred to LCS by pulmonary clinicians. These findings indicate areas for improvement in implementation and documentation of SDM. Variation in documentation of SDM among individuals screened for lung cancer underscores the need for interventions that facilitate high-quality SDM use and improved documentation.