Jennifer A Lewis1,2, Heidi Chen3, Kathryn E Weaver4, Lucy B Spalluto1,5, Kim L Sandler5, Leora Horn2, Robert S Dittus1,6, Pierre P Massion7,8, Christianne L Roumie1,6, Hilary A Tindle1,6. 1. aGeriatric Research, Education and Clinical Center, Veterans Health Administration - Tennessee Valley Healthcare System, Nashville, Tennessee. 2. bDivision of Hematology/Oncology, Department of Medicine, and. 3. cDepartment of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee. 4. dDepartment of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina. 5. eDepartment of Radiology. 6. fDivision of General Internal Medicine and Public Health, Department of Medicine, and. 7. gDivision of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; and. 8. hDepartment of Medicine, Veterans Health Administration - Tennessee Valley Healthcare System, Nashville, Tennessee.
Abstract
BACKGROUND: Despite widespread recommendation and supportive policies, screening with low-dose CT (LDCT) is incompletely implemented in the US healthcare system. Low provider knowledge of the lung cancer screening (LCS) guidelines represents a potential barrier to implementation. Therefore, we tested the hypothesis that low provider knowledge of guidelines is associated with less provider-reported screening with LDCT. PATIENTS AND METHODS: A cross-sectional survey was performed in a large academic medical center and affiliated Veterans Health Administration in the Mid-South United States that comprises hospital and community-based practices. Participants included general medicine providers and specialists who treat patients aged >50 years. The primary exposure was LCS guideline knowledge (US Preventive Services Task Force/Centers for Medicare & Medicaid Services). High knowledge was defined as identifying 3 major screening eligibility criteria (55 years as initial age of screening eligibility, smoking status as current or former smoker, and smoking history of ≥30 pack-years), and low knowledge was defined as not identifying these 3 criteria. The primary outcome was self-reported LDCT order/referral within the past year, and the secondary outcome was screening chest radiograph. Multivariable logistic regression evaluated the adjusted odds ratio (aOR) of screening by knowledge. RESULTS: Of 625 providers recruited, 407 (65%) responded, and 378 (60.5%) were analyzed. Overall, 233 providers (62%) demonstrated low LCS knowledge, and 224 (59%) reported ordering/referring for LDCT. The aOR of ordering/referring LDCT was less among providers with low knowledge (0.41; 95% CI, 0.24-0.71) than among those with high knowledge. More providers with low knowledge reported ordering screening chest radiographs (aOR, 2.7; 95% CI, 1.4-5.0) within the past year. CONCLUSIONS: Referring provider knowledge of LCS guidelines is low and directly proportional to the ordering rate for LDCT in an at-risk US population. Strategies to advance evidence-based LCS should incorporate provider education and system-level interventions to address gaps in provider knowledge.
BACKGROUND: Despite widespread recommendation and supportive policies, screening with low-dose CT (LDCT) is incompletely implemented in the US healthcare system. Low provider knowledge of the lung cancer screening (LCS) guidelines represents a potential barrier to implementation. Therefore, we tested the hypothesis that low provider knowledge of guidelines is associated with less provider-reported screening with LDCT. PATIENTS AND METHODS: A cross-sectional survey was performed in a large academic medical center and affiliated Veterans Health Administration in the Mid-South United States that comprises hospital and community-based practices. Participants included general medicine providers and specialists who treat patients aged >50 years. The primary exposure was LCS guideline knowledge (US Preventive Services Task Force/Centers for Medicare & Medicaid Services). High knowledge was defined as identifying 3 major screening eligibility criteria (55 years as initial age of screening eligibility, smoking status as current or former smoker, and smoking history of ≥30 pack-years), and low knowledge was defined as not identifying these 3 criteria. The primary outcome was self-reported LDCT order/referral within the past year, and the secondary outcome was screening chest radiograph. Multivariable logistic regression evaluated the adjusted odds ratio (aOR) of screening by knowledge. RESULTS: Of 625 providers recruited, 407 (65%) responded, and 378 (60.5%) were analyzed. Overall, 233 providers (62%) demonstrated low LCS knowledge, and 224 (59%) reported ordering/referring for LDCT. The aOR of ordering/referring LDCT was less among providers with low knowledge (0.41; 95% CI, 0.24-0.71) than among those with high knowledge. More providers with low knowledge reported ordering screening chest radiographs (aOR, 2.7; 95% CI, 1.4-5.0) within the past year. CONCLUSIONS: Referring provider knowledge of LCS guidelines is low and directly proportional to the ordering rate for LDCT in an at-risk US population. Strategies to advance evidence-based LCS should incorporate provider education and system-level interventions to address gaps in provider knowledge.
Authors: Jennifer A Lewis; Lauren R Samuels; Jason Denton; Gretchen C Edwards; Michael E Matheny; Amelia Maiga; Christopher G Slatore; Eric Grogan; Jane Kim; Robert H Sherrier; Robert S Dittus; Pierre P Massion; Laura Keohane; Sayeh Nikpay; Christianne L Roumie Journal: JNCI Cancer Spectr Date: 2020-06-13
Authors: Jennifer A Lewis; Nicole Senft; Heidi Chen; Kathryn E Weaver; Lucy B Spalluto; Kim L Sandler; Leora Horn; Pierre P Massion; Robert S Dittus; Christianne L Roumie; Hilary A Tindle Journal: BMC Health Serv Res Date: 2021-01-07 Impact factor: 2.655
Authors: David E Gerber; Heidi A Hamann; Olivia Dorsey; Chul Ahn; Jessica L Phillips; Noel O Santini; Travis Browning; Cristhiaan D Ochoa; Joyce Adesina; Vijaya Subbu Natchimuthu; Eric Steen; Harris Majeed; Amrit Gonugunta; Simon J Craddock Lee Journal: Clin Lung Cancer Date: 2020-12-11 Impact factor: 4.840