Lung cancer screening: What do physicians say to reluctant patients and what do patients want them to say?

Abstract

Objective: Lung cancer screening (LCS) can detect lung cancer at an earlier stage and reduce lung cancer mortality but can also cause harm. Therefore, physicians are tasked with conveying complex information to help patients make informed decisions. Studies suggest physicians often fall short of this. We characterize how physicians respond to a patient reluctant to undergo LCS and identify communication elements patients respond favorably to.

Method: Physicians responded to a vignette of a reluctant patient. Analogue patients (APs) rated responses and described their preferred response. We analyzed both physician and AP qualitative responses using content analysis and compared mean ratings of physician responses with a particular communication element present to responses without that element.

Results: We identified 19 communication elements in 42 physician responses and 24 elements in 64 AP responses. We identified 5 elements that were associated with higher AP ratings and how often physicians engaged in them (e.g., showing desire to understand the patient as a person, occurring in 21 % of responses.) CONCLUSION: We identify communication elements in physician and AP responses and reveal gaps between patients' desires and strategies employed by physicians.

Practical implications: Findings suggest that incorporating specific communication behaviors may enhance patient receptivity regarding LCS.

Keywords: Cancer; Cancer screening; Communication; Mixed methods; Mixed methods research; Physician patient communication; Screening.