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Gus Iversen, Editor in Chief | July 11, 2025
A new analysis of Medicare data suggests that shared decision-making (SDM) visits prior to initial lung cancer screening significantly improve patient adherence to annual follow-up screenings over multiple years.
The study, published in CHEST and led by researchers at the Harvey L. Neiman Health Policy Institute, examined a 5% national sample of Medicare fee-for-service beneficiaries from 2015 to 2020. Among more than 22,000 patients who underwent initial low-dose CT (LDCT) screening between 2016 and 2019, only 11.4% had a documented SDM visit within 90 days before screening. However, those who did were up to 32.5% more likely to continue with recommended annual screenings over the next four years.
“We found that patients who had a shared decision-making visit with their provider were more likely to remain engaged with lung cancer screening over time,” said lead author YoonKyung Chung, principal researcher at the Neiman Institute. “This effect was consistent even after adjusting for patient, clinician, and practice-level factors.”
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The study found first-year follow-up screening adherence was 26.5% higher for the SDM group, compared to those without an SDM visit. The gap widened to 32.5% by the fourth year.
Annual adherence to LDCT screening is critical for detecting lung cancer at an early stage. Prior research has shown poor long-term adherence, with fewer than 6% of patients completing a third consecutive annual screen.
Despite Medicare requirements mandating SDM for lung cancer screening eligibility, the study noted persistently low adoption, with rates plateauing just above 12%. Researchers cited possible barriers including time constraints and lack of enforcement.
“Routine shared decision making can serve as educational encounters to align screening services with patient preference,” said Dr. Ruth Carlos, professor of radiology at Columbia University.
The authors suggest that increasing use of SDM could serve as a practical strategy to improve screening program effectiveness as CMS guidelines continue to evolve.
