Telehealth and In-Person Lung Cancer Screening Consultations Show Equivalent Quality

Optimizing Shared Decision-Making in Lung Cancer Screening

Lung cancer remains a leading cause of mortality in the United States, although recent data show that improvements in early detection and treatment have significantly accelerated declines in death rates [1, 2]. To maximize these gains, clinical guidelines emphasize the necessity of shared decision-making, a process that ensures screening choices align with individual patient values and goals [3, 4]. While low-dose computed tomography is effective at reducing mortality, real-world implementation often struggles with low participation rates and barriers to access [5, 6]. Interventions such as patient navigation and decision aids have been shown to improve screening uptake, yet the impact of the delivery medium itself remains a critical question for busy practices [7, 6]. A new study now evaluates how the shift toward telehealth affects the quality of these essential clinical conversations.

Comparative Analysis of Consultation Modalities

The researchers conducted an evaluation of patients across 7 Veterans Affairs hospitals who had participated in shared decision-making for lung cancer screening within the preceding month. To assess the quality of these clinical encounters, the study authors distributed a mail survey to a total of 1033 patients. This methodology aimed to capture real-world patient perceptions of the counseling process shortly after the clinical interaction occurred, ensuring that the data reflected current practice patterns within the Veterans Affairs health system. The survey effort yielded a response rate of 31.0%, with 320 patients returning the questionnaire. However, the final analysis required a more refined subset to ensure data integrity. The researchers excluded 121 respondents from the final results because these individuals either could not recall the specific lung cancer screening conversation or had missing data regarding the primary exposure (the modality of the visit) or the primary outcome (the perceived quality of the decision-making process). This exclusion process was designed to minimize recall bias, which occurs when a patient's memory of an event is inaccurate or incomplete, and ensure that the findings were based on complete clinical datasets. Following these exclusions, the final cohort consisted of 199 patients. This group was nearly evenly split between the two primary consultation modalities under investigation. Specifically, 101 patients received their shared decision-making consultation in-person, while 98 patients engaged via telehealth. This balanced distribution allowed for a direct comparison between traditional face-to-face visits and remote consultations, providing a clear framework to evaluate whether the delivery medium influenced patient-reported outcomes or subsequent adherence to screening protocols.

Evaluating Shared Decision-Making Quality and Patient Perception

To quantify the effectiveness of these clinical encounters, the researchers utilized the CollaboRATE score as their primary outcome measure. This validated tool is a patient-reported instrument designed to assess the three core effort-based tasks of shared decision-making: how much effort the clinician made to help the patient understand their health issues, how much effort was made to listen to what mattered most to the patient, and how much effort was made to include the patient's preferences in the final decision. In this study, a top score of 27 on the scale was used to define high-quality shared decision-making, providing a rigorous threshold for evaluating whether the consultation met the highest standards of patient-centered care. The analysis of the 199-patient cohort revealed that 34.2% (68/199) of the total participants reported receiving high-quality shared decision-making. When the researchers compared the two delivery methods, they found that the modality of the consultation did not significantly influence these perceptions. Specifically, there was no significant difference in the likelihood of achieving high-quality shared decision-making between the groups, with an adjusted odds ratio of 0.76 (95% CI, 0.398-1.448) for telehealth versus in-person visits. An adjusted odds ratio is a statistical measure that compares the likelihood of an outcome between two groups while controlling for potential confounding variables. These findings suggest that clinicians can maintain the integrity of the shared decision-making process for lung cancer screening regardless of whether the conversation occurs in a traditional office setting or via a remote telehealth platform.

Clinical Adherence and Secondary Outcomes

Beyond the primary quality metrics, the researchers evaluated several secondary outcomes to determine if the consultation modality influenced the interpersonal aspects of the clinical encounter. These measures included decision satisfaction, perceived provider empathy, and the alignment of decision-making with the patient's preferred style. The study found no significant differences between the in-person and telehealth groups across these domains. Specifically, patients reported similar levels of satisfaction with their final screening choice and perceived their clinicians as equally empathetic regardless of whether the discussion occurred face-to-face or via a remote platform. Furthermore, the degree to which the clinician matched the patient's desired level of involvement in the decision-making process remained consistent across both modalities. The study also addressed critical clinical interventions and longitudinal follow-up, such as the provision of smoking cessation counseling for patients who were current smokers. There were no significant differences between the two modalities in the delivery of this counseling, suggesting that telehealth does not hinder the clinician's ability to address tobacco use during a screening consultation. To track the actual clinical impact of these discussions, the researchers utilized the Corporate Data Warehouse (a centralized repository of clinical and administrative data used for longitudinal tracking) to determine adherence to the initial lung cancer screening scan. The findings indicated that lung cancer screening decisions and subsequent adherence to the scheduled imaging were similar regardless of the consultation modality. This suggests that the transition to telehealth does not negatively impact the likelihood of a patient following through with the recommended diagnostic imaging.

Addressing the Educational Material Gap in Virtual Care

While most clinical and interpersonal outcomes were comparable across modalities, the researchers identified a notable discrepancy in the distribution of supplemental resources. Educational materials were provided significantly more often during in-person discussions (40.6%) than during telehealth discussions (22.6%), a difference that reached statistical significance with a p-value of .008. This gap suggests that while the verbal components of shared decision-making translate effectively to virtual platforms, the physical hand-off of brochures or decision aids remains more consistent in traditional office settings. For clinicians, this finding highlights a specific area for process improvement, such as the integration of digital patient education tools or automated mailing systems to ensure telehealth patients receive the same level of supplemental information as those seen in person. Despite the lower rate of material distribution, the overall equivalence in decision quality and scan adherence suggests that remote consultations are a viable alternative to face-to-face visits. The researchers concluded that telehealth for lung cancer screening shared decision-making may serve as a tool to improve equity and access by reducing barriers to screening uptake. By eliminating the need for travel to one of the seven Veterans Affairs hospitals involved in the study, virtual platforms can reach populations that might otherwise defer screening due to logistical or geographic constraints. As healthcare systems continue to refine their digital workflows, addressing the educational material gap could further strengthen telehealth as a robust method for delivering high-quality, patient-centered preventive care.

References

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