在退伍军人医疗中心实施远程医疗共享咨询和决策访问肺癌筛查。

Richard M Hoffman, Julie A Lang, George J Bailey, James A Merchant, Aaron S Seaman, Elizabeth A Newbury, Rolando Sanchez, Robert J Volk, Lisa M Lowenstein, Sarah L Averill
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引用次数: 0

摘要

背景:退伍军人患肺癌的发病率和死亡率都很高。肺癌筛查(LCS)与低剂量计算机断层扫描(LDCT)可以降低死亡率。指南建议进行咨询和共同决策(SDM),以解决筛查的益处和危害以及在患者接受筛查之前戒烟的重要性。观察:我们在爱荷华市退伍军人事务医疗中心实施了一个集中的LCS项目,由护士项目协调员(NPC)领导电话访问。我们的多学科团队确保从初级保健转介的退伍军人符合资格标准,LDCT结果被放射学正确编码,肺部及时评估异常的LDCT。全国人大给这位老兵寄去了一份决策援助函,并安排了一次SDM的电话访问。我们在访问后对退伍军人进行了调查,使用有效的措施来评估知识,决策冲突和决策质量。我们进行了105次SDM访问,91名退伍军人同意LDCT。总体而言,84%的退伍军人表示没有决策冲突,59%的人表示做出了高质量的决策。虽然大多数退伍军人正确回答了有关辐射危害、假阳性结果和过度诊断的问题,但很少有人知道何时停止筛查,而且大多数人高估了筛查的好处和异常扫描的预测价值。对72名目前吸烟的退伍军人进行了戒烟干预。结论:我们成功实施了一项LCS计划,该计划使用集中式远程医疗模型提供SDM和戒烟支持。虽然退伍军人对筛选决策有信心,但知识测试显示出重要的缺陷,许多人没有有意义地参与SDM。临床医生应该在转诊时以患者为中心,强调SDM的重要性,并能够提供足够的决策支持。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Implementing a Telehealth Shared Counseling and Decision-Making Visit for Lung Cancer Screening in a Veterans Affairs Medical Center.

Background: Veterans suffer substantial morbidity and mortality from lung cancer. Lung cancer screening (LCS) with low-dose computed tomography (LDCT) can reduce mortality. Guidelines recommend counseling and shared decision-making (SDM) to address the benefits and harms of screening and the importance of tobacco cessation before patients undergo screening.

Observations: We implemented a centralized LCS program at the Iowa City Veterans Affairs Medical Center with a nurse program coordinator (NPC)-led telephone visit. Our multidisciplinary team ensured that veterans referred from primary care met eligibility criteria, that LDCT results were correctly coded by radiology, and that pulmonary promptly evaluated abnormal LDCT. The NPC mailed a decision aid to the veteran and scheduled a SDM telephone visit. We surveyed veterans after the visit using validated measures to assess knowledge, decisional conflict, and quality of decision making. We conducted 105 SDM visits, and 91 veterans agreed to LDCT. Overall, 84% of veterans reported no decisional conflict, and 59% reported high-quality decision making. While most veterans correctly answered questions about the harms of radiation, false-positive results, and overdiagnosis, few knew when to stop screening, and most overestimated the benefit of screening and the predictive value of an abnormal scan. Tobacco cessation interventions were offered to 72 currently smoking veterans.

Conclusions: We successfully implemented an LCS program that provides SDM and tobacco cessation support using a centralized telehealth model. While veterans were confident about screening decisions, knowledge testing indicated important deficits, and many did not engage meaningfully in SDM. Clinicians should frame the decision as patient centered at the time of referral, highlight the importance of SDM, and be able to provide adequate decision support.

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