In Reply We thank Dobler for her interest in our article1 and for amplifying a key point in our discussion. As she notes in her letter and in a recent commentary,2 patient preferences are influenced by practice setting, timing, and framing of discussions with health care providers along the care continuum. We agree that a tertiary low-dose computed tomography screening program is not an optimal context for an initial discussion of the trade-offs involved in lung cancer screening. Most importantly, as Dobler states, absent a basic initial conversation about the benefits and harms of screening, patients will likely assume that a referral to a lung cancer screening program is a referral for the screening procedure itself, rather than to decide whether screening is right for them. We reiterate that this view is supported by studies showing that although 95% of patients receiving decision support in a tertiary screening context chose screening,3 only 50% of patients viewing a screening decision aid in a primary care context indicated a preference for screening.4
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Reuland DS, Malo TL, Brenner AT. Shared Decision Making Rarely Happens for Lung Cancer Screening—Reply. JAMA Intern Med. 2019;179(1):122–123. doi:10.1001/jamainternmed.2018.6986
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