Shared Decision-Making: A Missed Opportunity or a Key to Improving CT Lung Cancer Screening Rates?

Despite being one of the most effective tools for early lung cancer detection, CT lung cancer screening remains underutilized across the United States. Even more than a decade after national guidelines recommended its use for high-risk populations, overall screening rates remain far below target.

One potential solution may be hiding in plain sight: meaningful, proactive conversations between clinicians and patients.

Recent data continues to suggest that when patients engage in shared decision-making (SDM) conversations with their providers about CT lung cancer screening, they are significantly more likely to follow through with both initial and follow-up exams. Yet, uptake of these discussions remains surprisingly low.

So why aren’t more providers engaging in shared decision-making when it comes to lung screening?

For some, the perceived burden of SDM such as the time required, lack of reimbursement, or misunderstanding of the CMS requirements may be part of the issue. Others may not fully recognize its impact on patient behavior. However, emerging evidence supports that these discussions aren’t just a regulatory formality they’re a chance to build trust, explain the benefits of early detection, and address misconceptions or fears.

At ISCT, we believe this underscores a broader truth: education and engagement are essential in improving screening compliance and, ultimately, patient outcomes. Whether through enhanced provider training, the use of decision aids, or integrated care pathways, empowering clinicians to have these conversations can play a pivotal role in increasing adherence to recommended screening intervals.

What Can Be Done?

• Make SDM easier: Institutions can support clinicians with templates, talking points, or dedicated time during visits for these discussions.

• Elevate awareness: Continued education about the value of SDM and the evidence behind it can shift the narrative from regulatory burden to clinical opportunity.

• Build partnerships: Patient navigators and multidisciplinary teams can help bridge communication gaps and ensure consistent follow-up.

As CT technology and imaging guidelines evolve, so too must our approach to patient engagement. Let’s move beyond compliance and focus on connection because when patients understand why a scan matters, they’re far more likely to say yes to their health.