{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T04:09:05Z","timestamp":1793074145306,"version":"4.5.0"},"reference-count":51,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Lung cancer screening (LCS) is underused in the US, particularly in underserved populations, and little is known about factors associated with declining LCS. Guidelines call for shared decision-making when LCS is offered to ensure informed, patient-centered decisions.<\/jats:p><\/jats:sec>Objective<\/jats:title>To assess how frequently veterans decline LCS and examine factors associated with declining LCS.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective cohort study included LCS-eligible US veterans who were offered LCS between January 1, 2013, and February 1, 2021, by a clinician at 1 of 30 Veterans Health Administration (VHA) facilities that routinely used electronic health record clinical reminders documenting LCS eligibility and veterans\u2019 decisions to accept or decline LCS. Data were obtained from the Veterans Affairs (VA) Corporate Data Warehouse or Medicare claims files from the VA Information Resource Center.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The main outcome was documentation, in clinical reminders, that veterans declined LCS after a discussion with a clinician. Logistic regression analyses with clinicians and facilities as random effects were used to assess factors associated with declining LCS compared with agreeing to LCS.<\/jats:p><\/jats:sec>Results<\/jats:title>Of 43\u202f257 LCS-eligible veterans who were offered LCS (mean [SD] age, 64.7 [5.8] years), 95.9% were male, 84.2% were White, and 37.1% lived in a rural zip code; 32.0% declined screening. Veterans were less likely to decline LCS if they were younger (age 55-59 years: odds ratio [OR], 0.69; 95% CI, 0.64-0.74; age 60-64 years: OR, 0.80; 95% CI, 0.75-0.85), were Black (OR, 0.80; 95% CI, 0.73-0.87), were Hispanic (OR, 0.62; 95% CI, 0.49-0.78), did not have to make co-payments (OR, 0.92; 95% CI, 0.85-0.99), or had more frequent VHA health care utilization (outpatient: OR, 0.70; 95% CI, 0.67-0.72; emergency department: OR, 0.86; 95% CI, 0.80-0.92). Veterans were more likely to decline LCS if they were older (age 70-74 years: OR, 1.27; 95% CI, 1.19-1.37; age 75-80 years: OR, 1.93; 95% CI, 1.73-2.17), lived farther from a VHA screening facility (OR, 1.06; 95% CI, 1.03-1.08), had spent more days in long-term care (OR, 1.13; 95% CI, 1.07-1.19), had a higher Elixhauser Comorbidity Index score (OR, 1.04; 95% CI, 1.03-1.05), or had specific cardiovascular or mental health conditions (congestive heart failure: OR, 1.25; 95% CI, 1.12-1.39; stroke: OR, 1.14; 95% CI, 1.01-1.28; schizophrenia: OR, 1.87; 95% CI, 1.60-2.19). The clinician and facility offering LCS accounted for 19% and 36% of the variation in declining LCS, respectively.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study, older veterans with serious comorbidities were more likely to decline LCS and Black and Hispanic veterans were more likely to accept it. Variation in LCS decisions was accounted for more by the facility and clinician offering LCS than by patient factors. These findings suggest that shared decision-making conversations in which patients play a central role in guiding care may enhance patient-centered care and address disparities in LCS.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.27126","type":"journal-article","created":{"date-parts":[[2022,8,16]],"date-time":"2022-08-16T15:04:41Z","timestamp":1660662281000},"page":"e2227126","source":"Crossref","is-referenced-by-count":18,"title":["Factors Associated With Declining Lung Cancer Screening After Discussion With a Clinician in a Cohort of US Veterans"],"prefix":"10.1001","volume":"5","author":[{"given":"Eduardo R.","family":"N\u00fa\u00f1ez","sequence":"first","affiliation":[{"name":"Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts"},{"name":"The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts"},{"name":"VA Bedford Healthcare System, Bedford, 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Boston, Massachusetts"},{"name":"VA Bedford Healthcare System, Bedford, Massachusetts"},{"name":"National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirley X.","family":"Qian","sequence":"additional","affiliation":[{"name":"Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline H.","family":"Boudreau","sequence":"additional","affiliation":[{"name":"Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts"},{"name":"VA Bedford Healthcare System, Bedford, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald R.","family":"Miller","sequence":"additional","affiliation":[{"name":"Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts"},{"name":"VA Bedford Healthcare System, Bedford, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher G.","family":"Slatore","sequence":"additional","affiliation":[{"name":"National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC"},{"name":"Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon"},{"name":"Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renda Soylemez","family":"Wiener","sequence":"additional","affiliation":[{"name":"Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts"},{"name":"The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts"},{"name":"VA Bedford Healthcare System, Bedford, Massachusetts"},{"name":"National Center for Lung Cancer 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