Shared Decision-Making in Lung Cancer Screening: A Collaborative Approach
ACP 2025: Kim Sandler, MD, explains how primary care physicians can use shared decision-making to guide patients through lung cancer screening, emphasizing risk, benefit, follow-up, and smoking cessation.
In this interview, Kim Sandler, MD, codirector of the Vanderbilt Lung Screening Program and associate professor of radiology and radiological sciences at Vanderbilt University Medical Center, discusses the critical role of primary care physicians in lung cancer screening—particularly around shared decision-making. Lung screening is the first imaging test that requires a shared decision-making visit, creating a unique opportunity for clinicians to guide patients through the risks, benefits, and next steps associated with low-dose CT screening.
At the American College of Physicians Internal Medicine Meeting 2025, April 3-5, in New Orleans, Dr Sandler sat down with Patient Care and outlined how physicians can effectively engage patients in these conversations, what to emphasize when abnormal results are found, and why continued annual screening and smoking cessation counseling are essential to reducing lung cancer mortality.
The following transcript has been edited for clarity, style, and length.
Patient Care: You also mentioned the importance of shared decision-making in lung cancer screening. How can primary care physicians effectively engage their patients in this process?
Kim Sandler, MD: Lung cancer screening is unique in that it was the first imaging study to require a shared decision-making visit. It's a great opportunity for primary care providers to partner with patients and discuss both the risks and benefits of screening.
These conversations should include the importance of adherence—lung screening is recommended annually, and we only see the full mortality benefit when patients return each year after an initial normal scan. It's also important to talk about radiation exposure and, critically, smoking cessation. Quitting smoking is one of the most impactful things we can support for patients who are still smoking.
So, during that shared decision-making visit, the focus should be on understanding the risks and benefits, encouraging annual follow-up, and providing support for smoking cessation.
Patient Care: Can you discuss the importance of counseling patients about both the risks and benefits of screening? What key points should physicians emphasize?
Dr Sandler: Definitely. One important point to emphasize is that most screening studies come back normal—most patients won’t have any signs of lung cancer. And even when we do find something abnormal, it’s often not cancer.
If a nodule is detected, we usually don't recommend an immediate biopsy. In many cases, we’ll ask the patient to return in three or six months so the radiologist can monitor for any changes in size or appearance that might raise concern. It’s important to reassure patients that an abnormal result doesn’t automatically mean cancer, and that careful follow-up is standard.
But ultimately, early detection is key. When we catch lung cancer early, the survival rates are excellent. That’s why lung cancer screening is such a powerful tool for reducing mortality—we have a real opportunity to save lives.
