Introduction In the United States, the Centers for Medicare & Medicaid Services (CMS) requires a counseling and shared decision-making (SDM) visit with a healthcare provider before patients receive their first lung cancer screening (LCS). CMS no longer limits the types of clinicians who can conduct the SDM visit. We conducted a multi-institution cluster randomized trial to evaluate the impact of using tobacco treatment counselors (centralized care, CC), versus usual care (UC), on the quality of SDM for LCS with primary care patients who currently smoke and are eligible for screening.

Methods Primary care clinicians (PCC) were randomized to have their LCS eligible patients with upcoming visits referred to a tobacco treatment program for cessation services and SDM (CC) or to UC visits with a PCC. Tobacco treatment counselors were trained in LCS and SDM skills. A script was provided for counselors to follow during their first counseling session with a patient. Data reported here are from 1-week follow-up assessments after the PCC visit.

Results Of 274 patients, 186 (67.9%) were female, 60 (21.9%) identified as Black, and 148 (54.0%) had a high school education or less. At the 1-week follow-up, CC patients had greater knowledge of LCS (mean correct responses 44.7% vs. 36.5%, P<.001), and lower decisional conflict (mean total scale scores, 26.7 [SD=18.8] vs. 37.2 [SD=21.4], P<.001), compared to UC patients. Shared Decision-Making Process Scale scores were higher for CC compared to UC patients (mean 3.09 [SD=1.13] on a 4-point scale, vs. 1.65 [SD=1.38], P<.001).

Discussion Tobacco counselors were able to deliver a high-quality SDM conversation about LCS with patients referred to cessation services.

Conclusion Training tobacco counselors in SDM skills appears a feasible and effective strategy for improving the quality of SDM prior to screening for lung cancer.