Table 2.

Spectrum of Information Clinicians Provide to Patients About LCS

	CMS informational element depicted in quote*
Clinician quote	Benefit: early detection/reduces lung cancer death	Harm: false positives/nodules	Harm: distress from nodule	Harm: overall radiation exposure	Process of LCS	Offers decision aid
“I tell people…it’s similar to the screening that one might do for breast cancer with mammography, women get regular mammography to detect early cancer, now we offer it to our veterans who have had history of smoking.”—Pulmonologist, site A	✓
“I usually say, ‘The recommendation is to screen for lung cancer. …If we find something, then there’s a team of doctors who will help you to figure out if this is something serious or not. The reason we’re doing this is so that we can detect [cancer] early so that we can treat early, prevent it from advancing to more serious illness.”—PCP, site D	✓	✓
“I say, ‘We have the screening tools that have been proven to be effective to find asymptomatic disease early…to screen for lung cancer. You’re at high risk. I would order this special CAT scan that doesn’t quite have as much radiation as the old traditional CT’s…There’s a good chance we’ll find something, we may need more tests, or we may find nothing and still we’d recommend screening annually for a period of time.”—PCP, site A	✓	✓		✓	✓
“I tell them that they have certain health factors that place them at high risk for…lung cancer. …The benefits of screening are…you can detect lung cancer within stage 1 or 2 where the treatments options are cure, versus stage 3 or 4 when the patient becomes symptomatic and the treatment options are usually for life extension only…Then I go over the nodules, about how frequent they are, I tell them, ‘Don’t freak out. If we do find something we’re going to watch it really closely. We have time frames depending on your nodule, the size, the shape, the density.’…Then I give them my example about breast mammograms and how it can cause anxiety and I’m like, ‘I’m here to talk to you. We have counselors, we have mental health people if you start feeling depressed or anxious, call me.’ And I give them my direct line so they feel like there’s a safety net.”—Screening nurse coordinator, site C	✓	✓	✓
“I say, ‘Lung cancer screening has been shown to decrease the risk of dying from lung cancer.…Before you agree I want you to know that 96% of abnormal CAT scans that show a little shadow are not going to be cancer. Could be from old infections you’ve had or other causes. So there’s a 96% chance if you have a shadow that we’re going to get another CAT scan down the road in either 3 or 6 months or a year to see if it changes..…Are you psychologically of mind where you can deal, you know, not freak out by knowing that you have a shadow that may or may not be bad for 3 or 6 months? Not all patients can handle that. These are low-dose CAT scans which are lower [radiation]…but still we don’t know exactly the long-term effects of getting yearly low-dose CAT scans for many years. So what do you think, Joe? I also can print out the VA information sheet if you’re interested in reading about this further.”—PCP, site B	✓	✓	✓	✓	✓	✓

*CMS also requires discussion of potential harm of overdiagnosis, but no clinician described reviewing this with patients