Grant: CIHR Fellowship

Health systems aim to encourage patients to be active participants in their care. This includes informing patients about their different treatment options, encouraging them to ask questions and discuss their concerns, and ensuring that their values and preferences guide treatment decisions. One process for placing patients at the centre of their own care is "shared decision-making" (SDM). It is a model of patient-provider communication that has been shown to increase patient knowledge and result in decisions that better reflect what matters most to patients. However, providers often say there is insufficient time to engage in SDM. One solution is to provide longer (or additional) consultations so that SDM can occur. Within a fee-for-service healthcare system like Canada, this would require paying providers for additional consultation time through the introduction of a new billing code for SDM. Canadian jurisdictions have considered this option, but as of yet none have implemented it. However, the Centers for Medicare and Medicaid Services (CMS) in the US have. In 2016, the CMS introduced a billing code for a SDM visit for high-risk patients who were considering lung cancer screening with a CT scan. Currently, only about 3% of eligible patients undergo lung cancer screening in the US. The belief is that by allocating addition time to engage in SDM, a greater proportion of patients will be screened, resulting in decreased lung cancer mortality. This study will be the first to evaluate the impact of this billing code for SDM on lung cancer screening rates. The evidence will be used to inform policy in the US, where there are established screening programs, and in Canada, where provinces are beginning to explore the potential of population-based lung cancer screening programs.