Anne C Melzer1,2, Sara E Golden3, Sarah S Ono3, Santanu Datta4, Matthew Triplette5,6, Christopher G Slatore7,8,3. 1. University of Minnesota, 5635, Division of Pulmonary, Allergy, Critical Care and Sleep, Minneapolis, Minnesota, United States. 2. Minneapolis VA Healthcare System, Center for Care Delivery and Outcomes Research, Minneapolis, Minnesota, United States; Anne.Melzer2@va.gov. 3. Portland VA Medical Center, 20088, Center to Improve Veteran Involvement in Care, Portland, Oregon, United States. 4. Duke University School of Medicine, 12277, Division of General Internal Medicine, Durham, North Carolina, United States. 5. Fred Hutchinson Cancer Research Center, 7286, Clinical Research Division, Seattle, Washington, United States. 6. University of Washington, 7284, Division of Pulmonary, Allergy, Critical Care and Sleep, Seattle, Washington, United States. 7. VA Portland Health Care System, Section of Pulmonary and Critical Care Medicine, Portland, Oregon, United States. 8. Oregon Health & Science University, Division of Pulmonary and Critical Care Medicine, Portland, Oregon, United States.
Abstract
RATIONALE: Despite a known mortality benefit, lung cancer screening (LCS) implementation has been unexpectedly slow. New programs face barriers to implementation, which may include lack of clinician engagement or beliefs that the intervention is not beneficial. OBJECTIVE: To evaluate diverse clinician perspectives on their views of LCS and their experience with LCS implementation and processes. METHODS: We performed a qualitative study of clinicians participating in LCS. Clinicians were drawn from three medical centers, representing diverse specialties and practice settings. All participants practiced at sites with formal lung cancer screening programs. We performed semi-structured interviews with probes designed to elicit opinions of LCS, perceived evidence gaps, and recommendations for improvements. Transcribed interviews were iteratively reviewed and coded using directed content analysis. RESULTS: Participants (n=24) included LCS coordinators, pulmonologists, physician and non-physician primary care providers (PCPs), a surgeon, and a radiologist. Most clinicians expressed that the evidence supporting LCS was adequate to support clinical adoption, though most PCPs had little direct knowledge and based decisions on local recommendations or endorsement by the US Preventative Services Task Force (USPSTF). Many PCPs endorsed lack of knowledge of eligibility requirements and screening strategy (e.g. annual while eligible). Clinicians with more lung cancer screening knowledge, including several PCPs, identified a number of gaps in the current evidence that tempered enthusiasm, including: unclear ideal screening interval, populations with high cancer risk that do not qualify under USPSTF, indications to stop screening, and the role of serious comorbidities. Support for centralized programs and LCS coordinators was strong, but not uniform. Clinicians were frustrated by time limitations during a patient encounter, costs to the patient, and issues with insurance coverage. Many gaps in informatics support were identified. Clinicians recommended working to improve informatics support, continuing to clarify clinician responsibilities, and working on increasing public awareness of LCS. CONCLUSIONS: Despite working within programs that have adopted many recommended care processes to support LCS, clinicians identified a number of issues in providing high-quality LCS. Many of these issues are best addressed by improved support of LCS within the electronic health record and continued education of staff and patients.
RATIONALE: Despite a known mortality benefit, lung cancer screening (LCS) implementation has been unexpectedly slow. New programs face barriers to implementation, which may include lack of clinician engagement or beliefs that the intervention is not beneficial. OBJECTIVE: To evaluate diverse clinician perspectives on their views of LCS and their experience with LCS implementation and processes. METHODS: We performed a qualitative study of clinicians participating in LCS. Clinicians were drawn from three medical centers, representing diverse specialties and practice settings. All participants practiced at sites with formal lung cancer screening programs. We performed semi-structured interviews with probes designed to elicit opinions of LCS, perceived evidence gaps, and recommendations for improvements. Transcribed interviews were iteratively reviewed and coded using directed content analysis. RESULTS:Participants (n=24) included LCS coordinators, pulmonologists, physician and non-physician primary care providers (PCPs), a surgeon, and a radiologist. Most clinicians expressed that the evidence supporting LCS was adequate to support clinical adoption, though most PCPs had little direct knowledge and based decisions on local recommendations or endorsement by the US Preventative Services Task Force (USPSTF). Many PCPs endorsed lack of knowledge of eligibility requirements and screening strategy (e.g. annual while eligible). Clinicians with more lung cancer screening knowledge, including several PCPs, identified a number of gaps in the current evidence that tempered enthusiasm, including: unclear ideal screening interval, populations with high cancer risk that do not qualify under USPSTF, indications to stop screening, and the role of serious comorbidities. Support for centralized programs and LCS coordinators was strong, but not uniform. Clinicians were frustrated by time limitations during a patient encounter, costs to the patient, and issues with insurance coverage. Many gaps in informatics support were identified. Clinicians recommended working to improve informatics support, continuing to clarify clinician responsibilities, and working on increasing public awareness of LCS. CONCLUSIONS: Despite working within programs that have adopted many recommended care processes to support LCS, clinicians identified a number of issues in providing high-quality LCS. Many of these issues are best addressed by improved support of LCS within the electronic health record and continued education of staff and patients.
Authors: Michaela Brtnikova; Jamie L Studts; Elise Robertson; L Miriam Dickinson; Jennifer K Carroll; Alex H Krist; John T Cronin; Russell E Glasgow Journal: BMC Prim Care Date: 2022-09-09
Authors: Peter J Mazzone; Gerard A Silvestri; Lesley H Souter; Tanner J Caverly; Jeffrey P Kanne; Hormuzd A Katki; Renda Soylemez Wiener; Frank C Detterbeck Journal: Chest Date: 2021-07-13 Impact factor: 9.410
Authors: Peter J Mazzone; Gerard A Silvestri; Lesley H Souter; Tanner J Caverly; Jeffrey P Kanne; Hormuzd A Katki; Renda Soylemez Wiener; Frank C Detterbeck Journal: Chest Date: 2021-07-13 Impact factor: 9.410