Jonathan M Iaccarino1, Jack Clark2,3, Rendelle Bolton2, Linda Kinsinger4, Michael Kelley5,6, Christopher G Slatore7,8, David H Au9,10, Renda Soylemez Wiener1,2,11. 1. 1 The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts. 2. 2 Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veteran's Affairs Hospital, Bedford, Massachusetts. 3. 3 Boston University School of Public Health, Boston, Massachusetts. 4. 4 National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, North Carolina. 5. 5 Medical Service, Durham VA Medical Center, Durham, North Carolina. 6. 6 Duke Cancer Institute and Department of Medicine, Duke University Medical Center, Durham, North Carolina. 7. 7 Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon. 8. 8 Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon. 9. 9 Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington. 10. 10 Division of Pulmonary Critical Care Medicine, University of Washington, Seattle, Washington; and. 11. 11 The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire.
Abstract
RATIONALE: Multiple guidelines now recommend low-dose computed tomography (LDCT) screening for lung cancer. Given their central role in the planning of LDCT screening programs, pulmonologists' beliefs about LDCT screening will affect the safety, cost-effectiveness, and success of LDCT screening implementation. OBJECTIVES: To assess pulmonologists' propensity to offer lung cancer screening and their perceptions about LDCT screening. METHODS: We performed a national web-based survey, administered July 2013 to February 2014, among all staff pulmonologists active in Veterans Health Administration pulmonary clinics. The primary outcome was screening propensity (on the basis of responses to clinical vignettes) in relation to guidelines. Using bivariate and multinomial logistic regression, we assessed how perceptions of the evidence, trade-offs, and barriers to implementation of LDCT screening programs affected propensity to screen. MEASUREMENTS AND MAIN RESULTS: Of 573 eligible pulmonologists e-mailed, 286 (49.9%) participated. Approximately one-half (52.4%) had a propensity for guideline-concordant screening, 22.7% for overscreening, and 24.9% for underscreening. In bivariate analyses, guideline concordance was associated with acceptance of trial evidence, guidelines, and the efficacy of screening. In multivariable models, underscreeners were more likely to cite the potential harms of screening (e.g., false-positive findings, radiation exposure, incidental findings, unfavorable cost-benefit ratio), as influential factors (relative risk, 3.9; 95% confidence interval, 1.5-9.67) and were less influenced by trial evidence and guidelines (relative risk, 0.06; 95% confidence interval, 0.02-0.2), as compared with guideline-concordant screeners. Local resource availability did not significantly affect screening propensity, but insufficient infrastructure and personnel were commonly perceived barriers to implementation. CONCLUSIONS: Pulmonologists have varied perceptions of the evidence and trade-offs of LDCT screening, leading to the potential for over- and underscreening. To minimize potential harms as LDCT screening is widely implemented, physicians must understand which patients are appropriate candidates and engage those patients in a shared decision-making process regarding the trade-offs of LDCT screening.
RATIONALE: Multiple guidelines now recommend low-dose computed tomography (LDCT) screening for lung cancer. Given their central role in the planning of LDCT screening programs, pulmonologists' beliefs about LDCT screening will affect the safety, cost-effectiveness, and success of LDCT screening implementation. OBJECTIVES: To assess pulmonologists' propensity to offer lung cancer screening and their perceptions about LDCT screening. METHODS: We performed a national web-based survey, administered July 2013 to February 2014, among all staff pulmonologists active in Veterans Health Administration pulmonary clinics. The primary outcome was screening propensity (on the basis of responses to clinical vignettes) in relation to guidelines. Using bivariate and multinomial logistic regression, we assessed how perceptions of the evidence, trade-offs, and barriers to implementation of LDCT screening programs affected propensity to screen. MEASUREMENTS AND MAIN RESULTS: Of 573 eligible pulmonologists e-mailed, 286 (49.9%) participated. Approximately one-half (52.4%) had a propensity for guideline-concordant screening, 22.7% for overscreening, and 24.9% for underscreening. In bivariate analyses, guideline concordance was associated with acceptance of trial evidence, guidelines, and the efficacy of screening. In multivariable models, underscreeners were more likely to cite the potential harms of screening (e.g., false-positive findings, radiation exposure, incidental findings, unfavorable cost-benefit ratio), as influential factors (relative risk, 3.9; 95% confidence interval, 1.5-9.67) and were less influenced by trial evidence and guidelines (relative risk, 0.06; 95% confidence interval, 0.02-0.2), as compared with guideline-concordant screeners. Local resource availability did not significantly affect screening propensity, but insufficient infrastructure and personnel were commonly perceived barriers to implementation. CONCLUSIONS: Pulmonologists have varied perceptions of the evidence and trade-offs of LDCT screening, leading to the potential for over- and underscreening. To minimize potential harms as LDCT screening is widely implemented, physicians must understand which patients are appropriate candidates and engage those patients in a shared decision-making process regarding the trade-offs of LDCT screening.
Entities:
Keywords:
early detection of cancer; health care surveys; lung neoplasms; physicians
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