Stakeholder Research Priorities to Promote Implementation of Shared Decision-Making for Lung Cancer Screening: An American Thoracic Society and Veterans Affairs Health Services Research and Development Statement.

Rationale: Shared decision-making (SDM) for lung cancer screening (LCS) is recommended in guidelines and required by Medicare, yet it is seldom achieved in practice. The best approach for implementing SDM for LCS remains unknown, and the 2021 U.S. Preventive Services Task Force calls for implementation research to increase uptake of SDM for LCS. Objectives: To develop a stakeholder-prioritized research agenda and recommended outcomes to advance implementation of SDM for LCS. Methods: The American Thoracic Society and VA Health Services Research and Development Service convened a multistakeholder committee with expertise in SDM, LCS, patient-centered care, and implementation science. During a virtual State of the Art conference, we reviewed evidence and identified research questions to address barriers to implementing SDM for LCS, as well as outcome constructs, which were refined by writing group members. Our committee (n = 34) then ranked research questions and SDM effectiveness outcomes by perceived importance in an online survey. Results: We present our committee's consensus on three topics important to implementing SDM for LCS: 1) foundational principles for the best practice of SDM for LCS; 2) stakeholder rankings of 22 implementation research questions; and 3) recommended outcomes, including Proctor's implementation outcomes and stakeholder rankings of SDM effectiveness outcomes for hybrid implementation-effectiveness studies. Our committee ranked questions that apply innovative implementation approaches to relieve primary care providers of the sole responsibility of SDM for LCS as highest priority. We rated effectiveness constructs that capture the patient experience of SDM as most important. Conclusions: This statement offers a stakeholder-prioritized research agenda and outcomes to advance implementation of SDM for LCS.

The long-term consequences of retrieval demands during working memory.

Although it is well known that distraction impairs immediate retrieval of items maintained in working memory (WM; e.g., during complex span tasks), some evidence suggests that these items are more likely to be recalled from episodic memory (EM) compared with items that were studied without any distraction (e.g., during simple span tasks). One account for this delayed advantage of complex span over simple span, or the McCabe effect (McCabe, Journal of Memory and Language, 58[2], 480-494, 2008), is that complex span affords covert retrieval opportunities that facilitate later retrieval from EM by cumulatively reactivating each successively presented item after distraction. This explanation focuses on the processing that occurs during presentation and maintenance of the items, but no work to date has explored whether the differential demands of immediate retrieval between simple and complex span may explain the effect. Accordingly, these experiments examined the impact of immediate retrieval demands on the McCabe effect by comparing typical immediate serial-recall instructions (i.e., recalling the words in their exact order of presentation) to immediate free-recall (Experiments 1-2) and no-recall (Experiments 2 and 3) instructions. The results suggested that the nature of retrieval may constrain the McCabe effect in some situations (Experiments 1-2), but its demands do not drive the McCabe effect given that it was observed in both serial-recall and no-recall conditions (Experiment 3). Instead, activities such as covert retrieval during the processing phase may underlie the McCabe effect, thus further evidencing the importance of processing in WM for the long-term retention of information.