RESUMO
BACKGROUND: Many organizations recommend clinicians use structured communication processes, referred to as shared decision-making, to improve patient-reported outcomes for patients considering lung cancer screening (LCS). RESEARCH QUESTION: Which components of high-quality patient-centered communication are associated with decision regret and distress? STUDY DESIGN AND METHODS: We conducted a prospective, longitudinal, repeated measures cohort study among patients undergoing LCS in three different health care systems. We surveyed participants using validated measures of decision regret, decision satisfaction, distress, and patient-clinician communication domains up to 1 year after the low-dose CT (LDCT) imaging for LCS. For longitudinal analyses, we applied a series of generalized estimating equations to measure the association of the patient as person communication domain, screening knowledge, and decision concordance with decision regret and distress. RESULTS: When assessed 2 to 4 weeks after the LDCT imaging, 202 respondents (58.9%) and eight respondents (2.3%) of 343 total respondents reported mild and moderate or severe decision regret, respectively, whereas 29 respondents (9.2%) of 315 total respondents reported mild distress and 19 respondents (6.0%) reported moderate or greater distress. The mean ± SD decision satisfaction scores (scale, 0-10) were 9.82 ± 0.89, 9.08 ± 1.54, and 6.13 ± 3.40 among those with no, mild, and moderate or severe regret, respectively. Distress scores remained low after the LDCT imaging, even among those with nodules. Patient-centered communication domains were not associated with decision regret or distress. INTERPRETATION: Patients undergoing LCS rarely experience moderate or greater decision regret and distress. Although many participants reported mild decision regret, most were very satisfied over the 1 year after LDCT imaging for LCS. Communication processes were not associated with regret and distress, suggesting that it may be challenging for communication interventions to reduce the harms of LCS.
RESUMO
Administrative burdens are the costs associated with receiving a service or accessing a program. Based on the Herd & Moynihan framework, they occur in three subcategories: learning costs, compliance costs, and psychological costs. Administrative burdens manifest inequitably, more significantly impacting vulnerable populations. Administrative burdens may impact the health of those trying to access services, and in some cases block access to health-promoting services entirely. This scoping review examined studies focused on the impact on patients of administrative burden administrative burden in health care settings in the U.S. following the passage of the Affordable Care Act. We queried databases for empirical literature capturing patient administrative burden, retrieving 1578 records, with 31 articles ultimately eligible for inclusion. Of the 31 included studies, 18 used quantitative methods, nine used qualitative methods, three used mixed methods, and one was a case study. In terms of administrative burden subcategories, most patient outcomes reported were learning (22 studies) and compliance costs (26 studies). Psychological costs were the most rarely reported; all four studies describing psychological costs were qualitative in nature. Only twelve studies connected patient demographic data with administrative burden data, despite previous research suggesting an inequitable burden impact. Additionally, twenty-eight studies assessed administrative burden and only three attempted to reduce it via an intervention, resulting in a lack of data on intervention design and efficacy.