Understanding barriers to lung cancer screening in primary care.

Published on Apr 21, 2020in Journal of Thoracic Disease2.895
· DOI :10.21037/JTD.2020.03.66
Julia M. Coughlin5
Estimated H-index: 5
(Rush University Medical Center),
Yanyu Zang1
Estimated H-index: 1
(Rush University Medical Center)
+ 10 AuthorsChristopher W. Seder20
Estimated H-index: 20
(Rush University Medical Center)
Sources
Abstract
Background Low-dose computed tomography (LDCT) scan for lung cancer screening is underutilized. Studies suggest that up to one-third of providers do not know the current lung cancer screening guidelines. Thus, identifying the barriers to utilization of LDCT scan is essential. Methods Primary care providers in three different healthcare settings in the United States were surveyed to assess provider knowledge of LDCT scan screening criteria, lung cancer screening practices, and barriers to the utilization of LDCT scan screening. Fisher's Exact, Chi-Squared, and Kruskal-Wallis tests were used to compare provider responses. Multivariable logistic regression was used to test the association between provider characteristics and the likelihood of utilizing LDCT scan for lung cancer screening. Results The survey was sent to 614 providers, with a 15.7% response rate. Overall, 29.2% of providers report never ordering LDCT scans for eligible patients. Providers practicing at a community or academic hospital more frequently order LDCT scans than those practicing at a safety net hospital. Academic- and community-based providers received a significantly higher mean knowledge score than safety net-based providers [academic 6.84 (SD 1.33), community 6.72 (SD 1.46), safety net 5.85 (SD 1.38); P<0.01]. Overall, only 6.2% of respondents correctly identified all six Centers for Medicare and Medicaid Services eligibility criteria when challenged with three incorrect criteria. Common barriers to utilization of LDCT scan included failure of the electronic medical record (EMR) to notify providers of eligible patients (54.7%), patient refusal (37%), perceived high false-positive rate leading to unnecessary procedures (18.9%), provider time constraints (16.8%), and lack of insurance coverage (13.7%). Conclusions Provider knowledge of lung cancer screening guidelines varies, perhaps contributing to underutilization of LDCT scan for lung cancer screening. Improved provider education at safety net hospitals and improving EMR-based best practice alerts may improve the rate of lung cancer screening.
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References21
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#1Ikenna C. Okereke (UTMB: University of Texas Medical Branch)H-Index: 15
#2Shawn P.E. Nishi (UTMB: University of Texas Medical Branch)H-Index: 14
Last. James S. Goodwin (UTMB: University of Texas Medical Branch)H-Index: 109
view all 4 authors...
Background: Lung cancer is the most common cancer killer annually, yet the overall rate of eligible patients who undergo screening with low-dose computed tomography (LDCT) is low. Our goal was to determine factors which were associated with the probability of obtaining lung cancer screening. Methods: The Clinformatics Data Mart (CDM) database, a national commercial health insurance database with over 18,000,000 enrollees, was queried to determine the rate of LDCT screening and factors which infl...
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#1Rebecca L. Siegel (ACS: American Cancer Society)H-Index: 68
#2Kimberly D. Miller (ACS: American Cancer Society)H-Index: 29
Last. Ahmedin Jemal (ACS: American Cancer Society)H-Index: 139
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: Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data, available through 2015, were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data, available through 2016, were collected by the Nati...
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The American College of Chest Physicians (ACCP) recently published recommendations for lung cancer screening based on key questions developed using the PICO (population, intervention, comparator, and outcome) format.
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#1Douglas E. Wood (UW: University of Washington)H-Index: 62
#2Ella A. Kazerooni (UM: University of Michigan)H-Index: 86
Last. Miranda HughesH-Index: 26
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: Lung cancer is the leading cause of cancer-related mortality in the United States and worldwide. Early detection of lung cancer is an important opportunity for decreasing mortality. Data support using low-dose computed tomography (LDCT) of the chest to screen select patients who are at high risk for lung cancer. Lung screening is covered under the Affordable Care Act for individuals with high-risk factors. The Centers for Medicare & Medicaid Services (CMS) covers annual screening LDCT for appr...
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#1Ahmedin Jemal (ACS: American Cancer Society)H-Index: 139
#2Stacey A. Fedewa (ACS: American Cancer Society)H-Index: 46
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#1Vani N. Simmons (USF: University of South Florida)H-Index: 23
#2Jhanelle E. Gray (USF: University of South Florida)H-Index: 32
Last. Gwendolyn P. Quinn (USF: University of South Florida)H-Index: 54
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Abstract Introduction Until recently, there has not been a valid and reliable screening test for lung cancer. As compared to chest X-ray, low-dose computed tomography (LDCT) lung cancer screening has demonstrated greater sensitivity resulting in lung cancer diagnosis at an earlier stage, thereby reducing lung cancer mortality among high-risk individuals by 20%. In the current study, we sought to examine knowledge and attitudes about LDCT screening for lung cancer among an ethnically and racially...
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#1Peter J. Mazzone (Cleveland Clinic)H-Index: 43
#2Amanda Tenenbaum (Cleveland Clinic)H-Index: 1
Last. Xiaofeng Wang (Cleveland Clinic)H-Index: 22
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Background Lung cancer screening is a complex balance of benefits and harms. A counseling and shared decision-making visit has been mandated to assist patients with the decision about participation in screening. To our knowledge, the impact of this visit on patient understanding and decisions has not been studied. Methods We developed a centralized counseling and shared decision-making visit for our lung cancer screening program. The visit included confirmation of eligibility for screening, educ...
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Rationale: The U.S. Preventive Services Task Force recommends annual low-dose computed tomography (LDCT) for lung cancer screening in high-risk individuals. Preventive healthcare is provided predominantly by primary care providers (PCPs). Successful implementation of a screening program requires acceptance and participation by both providers and patients, with available collaboration with pulmonologists.Objectives: To identify perceptions of and perspectives on lung cancer screening and implemen...
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#1Jennifer L. ErsekH-Index: 13
#2Jan M. EberthH-Index: 21
Last. Daniela B. FriedmanH-Index: 30
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BACKGROUND The results of the National Lung Screening Trial showed a 20% reduction in lung cancer mortality and a 6.7% reduction in all-cause mortality when high-risk patients were screened with low-dose computed tomography (LDCT) versus chest x-ray (CXR). The US Preventive Services Task Force has issued a grade B recommendation for LDCT screening, and the Centers for Medicare and Medicaid Services and private insurers now cover the screening cost under certain conditions. The purpose of this st...
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Abstract null null Objective null Sublobar resection is frequently offered to patients with small, peripheral lung cancers, despite the lack of outcome data from ongoing randomized clinical trials. Sublobar resection may be a particularly attractive surgical strategy for screen-detected lung cancers, which have been suggested to be less biologically aggressive than cancers detected by other means. Using prospective data collected from patients undergoing surgery in the National Lung Screening Tr...
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#1Robert M. Van Haren (University of Cincinnati Academic Health Center)H-Index: 17
#2Aaron M. Delman (University of Cincinnati Academic Health Center)H-Index: 1
Last. Sandra L. Starnes (University of Cincinnati Academic Health Center)H-Index: 24
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Background Low-dose CT (LDCT) screening reduces lung cancer mortality by at least 20%. The COVID-19 pandemic required an unprecedented shutdown in our institutional LDCT program. The purpose of this study was to examine the impact of COVID-19 on lung cancer screening and subsequent cancer diagnosis. Study Design We analyzed our prospective institutional LDCT screening database, which began in 2012. In all, 2,153 patients have participated. Monthly mean number of LDCTs were compared between basel...
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#1Dan J. Raz (City of Hope National Medical Center)H-Index: 20
#2Mohamed H Ismail (KP: Kaiser Permanente)H-Index: 3
Last. Michael K. Gould (KP: Kaiser Permanente)H-Index: 68
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Abstract Background Lung cancer screening (LCS) with low-dose computed tomography (LDCT) reduces lung cancer mortality in high-risk patients, but most of those eligible are not referred for screening, and most eligible smokers are not aware of LCS. Smoking cessation counseling may be an opportune time to educate smokers about LCS. Here we investigate the effect of LCS educational information on LDCT utilization and smoking cessation in LCS-eligible patients receiving smoking cessation counseling...
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Last. Wenbin Liu (Fujian Medical University)
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Background Limited diffusion of health technology has greatly halted the improvement of resource integration and healthcare outcomes. The importance of understanding the dynamics of health technology diffusion is increasingly highlighted. However, the dynamic mechanism of health technology diffusion in the context of the integrated care system (ICS) remained largely unknown. Purpose To develop and validate the scale on Dynamics of Health Technology Diffusion in Integrated Care System (DHTDICS) f...
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#2Annette McWilliams (UWA: University of Western Australia)H-Index: 11
Lung cancer is the number one cause of cancer death worldwide. The benefits of lung cancer screening to reduce mortality and detect early-stage disease are no longer in any doubt based on the results of two landmark trials using LDCT. Lung cancer screening has been implemented in the US and South Korea and is under consideration by other communities. Successful translation of demonstrated research outcomes into the routine clinical setting requires careful implementation and co-ordinated input f...
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