Lung Cancer Screening Shared Decision-Making Visit Note

Note Type: Lung Cancer Screening Shared Decision-Making Visit Note

Date: [Date]

Provider: [Name and credentials]

Reason for Visit: Counseling and shared decision-making for low-dose CT (LDCT) lung cancer screening.

Eligibility

DOB / Age: [DOB / Age]

Smoking History: [Pack-year calculation: packs per day × years smoked = total pack-years] (Show the explicit calculation. Include any periods of cessation or changes in intensity if provided.)

Smoking Status: [current smoker / former smoker] (If former, include quit year and years since quitting.)

Symptom Screen: [Explicit asymptomatic attestation addressing hemoptysis, unexplained weight loss, new or changed cough, unexplained dyspnea, and chest pain] (If chronic respiratory symptoms are present, document that they are stable and at baseline.)

Eligibility Determination: [Single-sentence eligibility statement, e.g., "Patient meets criteria for LDCT lung cancer screening based on the above."]

(If pack-years or quit interval cannot be determined, document what is missing and the plan to obtain the information. Do not place a screening order until eligibility is confirmed.)

Shared Decision-Making

Decision Aid Used: [Name or title of decision aid; format: paper / video / web-based; language or literacy accommodations if applicable] (If a decision aid was not used, document explicitly and explain why.)

Patient Goals and Preferences: [What matters most to the patient—early detection, avoiding procedures, concerns about radiation or anxiety, tolerance for follow-up testing]

Understanding Confirmed: [Documentation that questions were invited and addressed]

Decision Outcome: [proceed with LDCT screening / defer / decline] (If defer or decline, document rationale and when to revisit.)

Counseling Summary

• Benefits and Harms: [Summary of topics discussed—mortality benefit of early detection, false positives requiring additional imaging, diagnostic testing risks, overdiagnosis, incidental findings, low-dose radiation exposure; patient verbalized understanding]
• Comorbidities and Candidacy: [Relevant comorbidities affecting life expectancy or procedural risk; explicit attestation of ability and willingness to undergo diagnostic evaluation and curative-intent treatment if cancer is found, or document why screening is not recommended]
• Annual Adherence: [Counseling on importance of annual screening while eligible; plan for reminders and scheduling]
• Tobacco Counseling: [For current smokers: cessation advice given, pharmacotherapy or behavioral treatment offered, resources or referrals provided, patient response. For former smokers: abstinence reinforced, relapse prevention discussed.]

Assessment

[Problem-oriented assessment: lung cancer screening encounter with eligibility status; tobacco use disorder or history of tobacco use; relevant comorbidities influencing screening candidacy or treatment tolerance]

Plan

If proceeding with screening:

• [LDCT chest for lung cancer screening ordered; initial / subsequent]
• [Results communication plan and timeframe]
• [Annual recall mechanism: registry enrollment, reminder, or follow-up order]
• [Tobacco cessation support if applicable: referrals, medications, or resources]

If not proceeding:

• [Reason: symptomatic requiring diagnostic workup / not eligible / patient declined]
• [Next steps or revisit interval]

(Do not order LDCT for screening if the patient is symptomatic; document pivot to diagnostic evaluation instead.)