• Prepare to talk with patients by: 1) determining whether they're eligible and 2) designing a patient-centered recommendation based on the patient’s individual risk profile.
• Talk to patients using the checklist provided. Use the evidence-based, personalized method of discussing benefits and harms, so patients can understand the trade-offs of screening.
• Document your shared decision making in your medical record system with a simple copy and paste.
• Share a printable report with your patients.

• Evidence-Based Screening. Screening with low-dose computed tomography (LDCT) has been shown to reduce the number of deaths from lung cancer in groups at high risk.
• Compares favorably with other cancer screening tests. For perspective, the reduction in deaths from lung cancer with CT screening is larger than the reduction in deaths from the target cancers of other common screening tests, such as mammograms for breast cancer.
• Shared decision-making is recommended. The USPSTF recommends that health systems offer CT screening and that clinicians use shared decision making with patients, since there are both substantial benefits and substantial harms with CT screening.
• Shared decision-making is required for payment. Medicare requires the use of a shared decision-making tool and that shared decision-making be documented. This tool makes shared decision-making easier and documentation automatic.

Design and development

6-year lung cancer risk estimates

1. Bach PB, Elkin EB, Pastorino U, et al. Benchmarking lung cancer mortality rates in current and former smokers. Chest. Dec 2004;126(6):1742-1749.
2. Bach PB, Kattan MW, Thornquist MD, et al. Variations in lung cancer risk among smokers. J Natl Cancer Inst. Mar 19 2003;95(6):470-478.

Evidence basis for risk-based screening

1. Kovalchik SA, Tammemagi M, Berg CD, et al. Targeting of low-dose CT screening according to the risk of lung-cancer death. N Engl J Med. Jul 18 2013;369(3):245-254.
2. Katki HA, Kovalchik SA, Berg CD, Cheung LC, and Chaturvedi AK. “Development and Validation of Risk Models to Select Ever-Smokers for Ct Lung Cancer Screening.” JAMA 315, no. 21 (June 7, 2016): 2300–2311.
3. Tammemägi, Martin C., Hormuzd A. Katki, William G. Hocking, Timothy R. Church, Neil Caporaso, Paul A. Kvale, Anil K. Chaturvedi, et al. “Selection Criteria for Lung-Cancer Screening.” New England Journal of Medicine 368, no. 8 (2013): 728–36.
4. Modeling Study, Caverly, Cao, Hayward, Meza.