To the Editor In their study published in a recent issue of JAMA Internal Medicine, Brenner and colleagues1 demonstrated that true shared decision making (SDM) rarely takes place in consultations to discuss low-dose computed tomography (LDCT) screening for lung cancer, despite the fact that a counseling and SDM visit is required by the Centers for Medicare & Medicaid Services as a condition for reimbursement. The authors discussed the possibility that the timing of the SDM visit during the patient journey may be crucial, because patients attending a tertiary LDCT screening program have been found to be significantly more likely to opt for LDCT screening compared with patients who contemplated the option of LDCT screening in a primary care setting.2,3