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Qutob RA, Almehaidib IA, Alzahrani SS, Alabdulkarim SM, Abuhemid HA, Alassaf RA, Alaryni A, Alghamdi A, Alsolamy E, Bukhari A, Alotay AA, Alhajery MA, Alanazi A, Faqihi FA, Almaimani MK. Knowledge, Attitudes, and Practice Patterns of Lung Cancer Screening Among Physicians in Saudi Arabia. Cureus 2024; 16:e51842. [PMID: 38327913 PMCID: PMC10848281 DOI: 10.7759/cureus.51842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Lung cancer remains the primary cause of death connected to cancer on a worldwide scale. Obtaining a deep understanding of the knowledge, attitudes, and behavior patterns of doctors is essential for developing successful strategies to improve lung cancer screening. This study aims to identify the attitudes, beliefs, referral practices, and knowledge of lung cancer screening among physicians in Saudi Arabia. METHODS An online survey was conducted from July to December 2023 to investigate the attitudes, beliefs, referral practices, and knowledge of lung cancer screening, and adherence to lung cancer screening recommendations among physicians in Saudi Arabia. Internal medicine, family medicine, and pulmonology physicians of all levels (consultants, senior registrars, and residents) who are currently practicing medicine in Saudi Arabia formed the study population. This study employed a previously developed questionnaire. Binary logistic regression analysis was employed to identify factors that indicate a better degree of knowledge and a positive attitude toward lung cancer screening. RESULTS This study involved a total of 96 physicians. The study participants demonstrated a significant degree of understanding regarding lung cancer screening, with an average knowledge score of 5.8 (SD: 1.7) out of 8, equivalent to 72.5% of the highest possible score. The accuracy rate for knowledge items varied from 44.8% to 91.7%. The study participants had a moderately favorable attitude toward lung cancer screening, as shown by a mean attitude score of 14.4 (SD: 3.7) out of a maximum possible score of 30, which corresponds to 48.0% of the highest achievable score. Around 36.5% of the survey participants reported engaging in the practice of discussing the results of lung cancer screening with patients. The primary obstacles frequently cited were challenges in patient scheduling, insufficient time to discuss lung cancer screening during clinic appointments, and patient refusal, constituting 59.4%, 53.1%, and 53.1% of the identified barriers, respectively. Physicians in Saudi Arabia, particularly those employed in private hospitals, demonstrated a higher level of knowledge of lung cancer screening compared to others (p < 0.05). In contrast, individuals with 11-15 years of experience were shown to have a 78.0% lower likelihood of being educated about lung cancer screening compared to their counterparts (p < 0.05). CONCLUSION The study's results indicate that there is a need for the development of specialized educational initiatives aimed at Saudi Arabian physicians, particularly those with 11 to 15 years of experience who exhibit a limited understanding of lung cancer screening. Utilizing programs that provide continuing medical education would aid in their education. There is a need to facilitate communication between physicians and patients. It is critical to address the identified issues, such as streamlining the appointment scheduling process and ensuring patients have sufficient time during clinic visits. Furthermore, it is critical for the success of nationwide screening initiatives to foster collaboration between the public and private healthcare sectors.
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Affiliation(s)
- Rayan A Qutob
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Ibrahim Ali Almehaidib
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Sarah Saad Alzahrani
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Sara Mohammed Alabdulkarim
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Haifa Abdulrahman Abuhemid
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Reema Abdulrahman Alassaf
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Abdullah Alaryni
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Abdullah Alghamdi
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Eysa Alsolamy
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Abdullah Bukhari
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Abdulwahed Abdulaziz Alotay
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Mohammad A Alhajery
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Abdulrahman Alanazi
- Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Fahad Ali Faqihi
- Department of Internal Medicine and Adult Critical Care Medicine, Dr. Sulaiman Al Habib Medical Group Holding Company, Riyadh, SAU
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Changes in Physician Knowledge, Attitudes, Beliefs, and Practices regarding Lung Cancer Screening. Ann Am Thorac Soc 2020; 16:1065-1069. [PMID: 31075047 DOI: 10.1513/annalsats.201812-867rl] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Li J, Chung S, Martinez MC, Luft HS. Smoking-Cessation Interventions After Lung Cancer Screening Guideline Change. Am J Prev Med 2020; 59:88-97. [PMID: 32417022 DOI: 10.1016/j.amepre.2020.01.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Recent guideline changes for lung cancer screening with low-dose computed tomography recommend smoking-cessation interventions be done in parallel with screening. The purpose of this study is to determine the post-guideline rates of smoking-cessation interventions among patients eligible and ineligible for lung cancer screening. METHODS Using electronic health records collected from a large ambulatory care system in northern California between 2010 and 2017, authors identified new patients who were current smokers aged 55-80 years visiting a primary care provider, and grouped patients into lung cancer screening-eligible heavy smokers, screening-ineligible moderate smokers, and screening-ineligible light smokers. Screening-eligible smokers versus screening-ineligible smokers were compared in receipt of smoking-cessation interventions before (2010-2013) and after (2014-2017) the guideline change, overall and by intervention type (formal counseling, informal counseling, pharmacotherapy) using hierarchical generalized linear models. Analyses were conducted in 2018-2019. RESULTS After the guideline change, the likelihood of receiving any smoking-cessation intervention (OR=1.44, 95% CI=1.28, 1.61, p<0.05), informal counseling (OR=1.29, 95% CI=1.15, 1.46, p<0.05), and pharmacotherapy (OR=1.24, 95% CI=1.02, 1.50, p<0.05) during a new patient visit significantly increased, with the increase not varying by level of smoking. For formal counseling, the post-guideline increase was greater for screening-eligible heavy smokers (OR=3.15, 95% CI=1.18, 8.36, p<0.05) and moderate smokers (OR=3.58, 95% CI=1.29, 9.95, p<0.05) relative to light smokers. CONCLUSIONS Smoking-cessation interventions increased after new lung cancer screening guidelines. Given the sizable adverse impacts of smoking on morbidity and mortality, small increases in the implementation of smoking-cessation interventions could have substantial public health benefits.
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Affiliation(s)
- Jiang Li
- Center for Health Systems Research, Sutter Health, Palo Alto Medical Foundation Research Institute, Palo Alto, California.
| | - Sukyung Chung
- Center for Health Systems Research, Sutter Health, Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Meghan C Martinez
- Center for Health Systems Research, Sutter Health, Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Harold S Luft
- Center for Health Systems Research, Sutter Health, Palo Alto Medical Foundation Research Institute, Palo Alto, California
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Healthcare professionals' perspectives on lung cancer screening in the UK: a qualitative study. BJGP Open 2020; 4:bjgpopen20X101035. [PMID: 32522753 PMCID: PMC7465573 DOI: 10.3399/bjgpopen20x101035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/29/2019] [Indexed: 12/19/2022] Open
Abstract
Background Lung cancer screening with low-dose computed tomography (LDCT) has been shown to decrease mortality. Low lung cancer survival rates in the UK, driven primarily by late-stage presentation, provide the impetus for implementing screening. Nascent guidance on screening in the UK recommends primary care case-finding. However, the potential impact and acceptability on primary care, and the opportunistic utilisation of other case-finding routes, such as pharmacies, smoking cessation services, and respiratory clinics, have not been fully explored. Aim To explore healthcare professionals’ views and perspectives about lung cancer screening and their preparedness and willingness to be involved in its implementation. Design & setting A qualitative study was carried out with semi-structured interviews conducted with GPs, pharmacists, staff from smoking cessation services within Southwark and Lambeth in London, and staff from respiratory clinics in Guys’ and St Thomas’ NHS Foundation Trust in London between April 2018 and December 2018. Method Sixteen participants were interviewed and the interview transcripts were analysed thematically. Results Participants described lung cancer screening as an important diagnostic tool for capturing lung cancer at an earlier stage and in increasing survivorship. However, the majority expressed a lack of awareness and understanding, uncertainty and concerns about the validity of screening, and the potential impact on their patients and workload. Conclusion Study participants had mixed opinions about lung cancer screening and expressed their concerns about its implementation. Addressing these concerns by providing resources and effective and detailed guidelines for their use may lead to greater engagement and willingness to be involved in lung cancer screening.
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Vella M, Meyer CS, Zhang N, Cohen BE, Whooley MA, Wang S, Hope MD. Association of Receipt of Positron Emission Tomography-Computed Tomography With Non-Small Cell Lung Cancer Mortality in the Veterans Affairs Health Care System. JAMA Netw Open 2019; 2:e1915828. [PMID: 31747036 PMCID: PMC6902817 DOI: 10.1001/jamanetworkopen.2019.15828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Positron emission tomography-computed tomography (PET-CT) has been increasingly used in the management of lung cancer, but its association with survival has not been convincingly documented. OBJECTIVE To examine the association of the use of PET-CT with non-small cell lung cancer (NSCLC) mortality in the US Department of Veterans Affairs (VA) health care system from 2000 to 2013. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 64 103 veterans receiving care in the VA health care system who were diagnosed with incident NSCLC between September 2000 and December 2013. Data analysis took place in October 2018. EXPOSURE Use of PET-CT before and/or after diagnosis. MAIN OUTCOMES AND MEASURES All-cause and NSCLC-specific 5-year mortality; secondary outcome was receipt of stage-appropriate treatment. RESULTS A total of 64 103 veterans with the diagnosis of NSCLC were evaluated; 62 838 (98.0%) were men, and 50 584 (78.9%) were white individuals. Among these, 51 844 (80.9%) had a PET-CT performed: 25 735 (40.1%) in the 12 months before diagnosis and 41 242 (64.3%) in the 5 years after diagnosis. Increased PET-CT use (597 of 978 veterans [59.2%] in 2000 vs 3649 of 3915 [93.2%] in 2013) and decreased NSCLC-specific 5-year mortality (879 of 978 veterans [89.9%] in 2000 vs 3226 of 3915 veterans [82.4%] in 2013) were found over time. Increased use of stage-appropriate therapy was also seen over time, from 346 of 978 veterans (35.4%) in 2000 to 2062 of 3915 (52.7%) in 2013 (P < .001). Increased PET-CT use was associated with higher-complexity level VA facilities (26 127 veterans [82.3%] at level 1a vs 1289 [75.2%] at level 3 facilities; P < .001) and facilities with on-site PET-CT compared with facilities without on-site PET-CT (33 081 [82.2%] vs 17 443 [80.3%]; P < .001). Use of PET-CT before diagnosis was associated with increased likelihood of stage-appropriate treatment for all stages of NSCLC (eg, veterans with stage 1 disease: 4837 of 7870 veterans [61.5%] who received PET-CT underwent surgical resection vs 4042 of 7938 veterans [50.9%] who did not receive PET-CT; P < .001) and decreased mortality in a risk-adjusted model among all participants and among veterans undergoing stage-appropriate treatment (all-cause mortality: hazard ratio [HR], 0.78; 95% CI, 0.77-0.79; NSCLC-specific mortality: HR, 0.78; 95% CI, 0.76-0.80). Facilities with on-site PET-CT and higher-complexity level facilities were associated with a mortality benefit, with 16% decreased mortality at level 1a vs level 3 facilities (HR, 0.84; 95% CI, 0.80-0.89) and a 3% decrease in all-cause mortality in facilities with on-site PET-CT (HR, 0.97; 95% CI, 0.96-0.99). CONCLUSIONS In this study, the use of PET-CT among veterans with NSCLC significantly increased from 2000 to 2013, coinciding with decreased 5-year mortality and an increase in stage-appropriate treatment. Variation in use of PET-CT was found, with the highest use at higher-complexity level facilities and those with PET-CT on-site. These facilities were associated with reduced all-cause and NSCLC-specific mortality.
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Affiliation(s)
- Maya Vella
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Craig S. Meyer
- Department of Medicine, University of California, San Francisco
| | - Ning Zhang
- Department of Medicine, University of California, San Francisco
| | - Beth E. Cohen
- Department of Medicine, University of California, San Francisco
- San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Mary A. Whooley
- Department of Medicine, University of California, San Francisco
- San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Sunny Wang
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Division of Hematology and Oncology, University of California, San Francisco
| | - Michael D. Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
- San Francisco Veterans Affairs Health Care System, San Francisco, California
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Maiga AW, Deppen SA, Massion PP, Callaway-Lane C, Pinkerman R, Dittus RS, Lambright ES, Nesbitt JC, Grogan EL. Communication About the Probability of Cancer in Indeterminate Pulmonary Nodules. JAMA Surg 2019; 153:353-357. [PMID: 29261826 DOI: 10.1001/jamasurg.2017.4878] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Clinical guidelines recommend that clinicians estimate the probability of malignancy for patients with indeterminate pulmonary nodules (IPNs) larger than 8 mm. Adherence to these guidelines is unknown. Objectives To determine whether clinicians document the probability of malignancy in high-risk IPNs and to compare these quantitative or qualitative predictions with the validated Mayo Clinic Model. Design, Setting, and Participants Single-institution, retrospective cohort study of patients from a tertiary care Department of Veterans Affairs hospital from January 1, 2003, through December 31, 2015. Cohort 1 included 291 veterans undergoing surgical resection of known or suspected lung cancer from January 1, 2003, through December 31, 2015. Cohort 2 included a random sample of 239 veterans undergoing inpatient or outpatient pulmonary evaluation of IPNs at the hospital from January 1, 2003, through December 31, 2012. Exposures Clinician documentation of the quantitative or qualitative probability of malignancy. Main Outcomes and Measures Documentation from pulmonary and/or thoracic surgery clinicians as well as information from multidisciplinary tumor board presentations was reviewed. Any documented quantitative or qualitative predictions of malignancy were extracted and summarized using descriptive statistics. Clinicians' predictions were compared with risk estimates from the Mayo Clinic Model. Results Of 291 patients in cohort 1, 282 (96.9%) were men; mean (SD) age was 64.6 (9.0) years. Of 239 patients in cohort 2, 233 (97.5%) were men; mean (SD) age was 65.5 (10.8) years. Cancer prevalence was 258 of 291 cases (88.7%) in cohort 1 and 110 of 225 patients with a definitive diagnosis (48.9%) in cohort 2. Only 13 patients (4.5%) in cohort 1 and 3 (1.3%) in cohort 2 had a documented quantitative prediction of malignancy prior to tissue diagnosis. Of the remaining patients, 217 of 278 (78.1%) in cohort 1 and 149 of 236 (63.1%) in cohort 2 had qualitative statements of cancer risk. In cohort 2, 23 of 79 patients (29.1%) without any documented malignancy risk statements had a final diagnosis of cancer. Qualitative risk statements were distributed among 32 broad categories. The most frequently used statements aligned well with Mayo Clinic Model predictions for cohort 1 compared with cohort 2. The median Mayo Clinic Model-predicted probability of cancer was 68.7% (range, 2.4%-100.0%). Qualitative risk statements roughly aligned with Mayo predictions. Conclusions and Relevance Clinicians rarely provide quantitative documentation of cancer probability for high-risk IPNs, even among patients drawn from a broad range of cancer probabilities. Qualitative statements of cancer risk in current practice are imprecise and highly variable. A standard scale that correlates with predicted cancer risk for IPNs should be used to communicate with patients and other clinicians.
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Affiliation(s)
- Amelia W Maiga
- Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, Nashville.,Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephen A Deppen
- Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, Nashville.,Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Pierre P Massion
- Department of Medicine, Tennessee Valley Healthcare System, Nashville.,Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Rhonda Pinkerman
- Department of Surgery, Tennessee Valley Healthcare System, Nashville
| | - Robert S Dittus
- Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, Nashville
| | - Eric S Lambright
- Department of Surgery, Tennessee Valley Healthcare System, Nashville.,Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan C Nesbitt
- Department of Surgery, Tennessee Valley Healthcare System, Nashville.,Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eric L Grogan
- Department of Surgery, Tennessee Valley Healthcare System, Nashville.,Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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O'Brien MA, Llovet D, Sullivan F, Paszat L. Primary care providers' views on a future lung cancer screening program. Fam Pract 2019; 36:501-505. [PMID: 30395205 DOI: 10.1093/fampra/cmy099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The National Lung Screening Trial demonstrated that screening with low-dose computed tomography significantly reduces mortality from lung cancer in high-risk individuals. OBJECTIVE To describe the role preferences and information needs of primary care providers (PCPs) in a future organized lung cancer screening program. METHODS We purposively sampled PCPs from diverse health regions of Ontario and from different practice models including family health teams and community health centres. We also recruited family physicians with a leadership role in cancer screening. We used focus groups and a nominal group process to identify informational priorities. Two analysts systematically applied a coding scheme to interview transcripts. RESULTS Four groups were held with 34 providers and administrative staff [28 (82%) female, 21 (62%) physicians, 7 (20%) other health professionals and 6 (18%) administrative staff]. PCPs and staff were generally positive about a potential lung cancer screening program but had variable views on their involvement. Informational needs included evidence of potential benefits and harms of screening. Most providers preferred that a new program be modelled on positive features of an existing breast cancer screening program. Lung cancer screening was viewed as a new opportunity to counsel patients about smoking cessation. CONCLUSIONS The development of a future lung cancer screening program should consider the wide variability in the roles that PCPs preferred. An explicit link to existing smoking cessation programs was seen as essential. As providers had significant information needs, learning materials and opportunities should be developed with them.
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Affiliation(s)
- Mary Ann O'Brien
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Diego Llovet
- Prevention & Cancer Control, Cancer Care Ontario, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Frank Sullivan
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,UTOPIAN Practice-based Research Network, University of Toronto, Toronto, Canada.,School of Medicine, University of St Andrews, UK
| | - Lawrence Paszat
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada.,Sunnybrook Research Institute, Toronto, Canada
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Lung cancer screening: Practice guidelines and insurance coverage are not enough. J Am Assoc Nurse Pract 2019; 31:33-45. [PMID: 30431549 DOI: 10.1097/jxx.0000000000000096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Low-dose computed tomography (LDCT) is expected to increase early detection of lung cancer and improve survival. The growth in the number of advanced nurse practitioners (NPs) in primary care settings increases the likelihood that an NP will serve as a patient's provider. This study's purpose was to examine knowledge, attitudes, and practices regarding LDCT among NPs who work in primary care settings. METHODS An explanatory, sequential, mixed-method design used a 32-item questionnaire, followed by a semi-structured telephone interview. The development of the survey and interview questions were guided by a conceptual framework representing a temporal sequence for behavior change and potential barriers to guideline adherence. CONCLUSIONS Nurse practitioners believe that shared decision making with their high-risk patients about LDCT is within their scope of their practice. Working in time-constrained primary care settings, NPs have limited abilities to improve the uptake of LDCT. Substantial patient barriers exist that deter follow through on providers' recommendation. Disseminating guidelines and authorizing health insurance reimbursement is insufficient. IMPLICATIONS FOR PRACTICE Research is needed that investigates the screening process so that barriers can be closely studied. Culture change is needed where early detection has greater value for insurers, providers, and patients.
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Eberth JM, McDonnell KK, Sercy E, Khan S, Strayer SM, Dievendorf AC, Munden RF, Vernon SW. A national survey of primary care physicians: Perceptions and practices of low-dose CT lung cancer screening. Prev Med Rep 2018; 11:93-99. [PMID: 29984145 PMCID: PMC6030390 DOI: 10.1016/j.pmedr.2018.05.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/16/2018] [Accepted: 05/14/2018] [Indexed: 12/30/2022] Open
Abstract
Soon after the National Lung Screening Trial, organizations began to endorse low-dose computed tomography (LCDT) screening for lung cancer in high-risk patients. Concerns about the risks versus benefits of screening, as well as the logistics of identifying and referring eligible patients, remained among physicians. This study aimed to examine primary care physicians' knowledge, attitudes, referral practices, and associated barriers regarding LDCT screening. We administered a national survey of primary care physicians in the United States between September 2016 and April 2017. Physicians received up to 3 mailings, 1 follow-up email, and received varying incentives to complete the survey. Overall, 293 physicians participated, for a response rate of 13%. We used weighted descriptive statistics to characterize participants and their responses. Over half of the respondents correctly reported that the US Preventive Services Task Force recommends LDCT screening for high-risk patients. Screening recommendations for patients not meeting high-risk criteria varied. Although 75% agreed that the benefits of LDCT screening outweigh the risks, fewer agreed that there is substantial evidence that screening reduces mortality (50%). The most commonly reported barriers to ordering screening included prior authorization requirements (57%), lack of insurance coverage (53%), and coverage denials (31%). The most frequently cited barrier to conducting LDCT screening shared decision making was patients' competing health priorities (42%). Given the impact of physician recommendations on cancer screening utilization, further understanding of physicians' LDCT screening attitudes and shared decision-making practices is needed. Clinical practice and policy changes are also needed to engage more patients in screening discussions. Most physicians had five or less lung cancer screening referrals in the past year Recommendation strategies varied, but often aligned with USPSTF or NCCN guidelines Physicians were uncertain about the efficacy and cost-effectiveness of screening Insurance coverage and costs were commonly cited as barriers to screening referral A common barrier to performing SDM was patients' competing health priorities
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Affiliation(s)
- Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | | | - Erica Sercy
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Samira Khan
- Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Scott M Strayer
- Department of Family and Preventive Medicine, School of Medicine, University of South Carolina, Columbia, SC, United States
| | - Amy C Dievendorf
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Reginald F Munden
- Department of Radiology, Wake Forest Baptist Medical Center, Winston Salem, NC, United States
| | - Sally W Vernon
- Department of Health Promotion & Behavioral Sciences, School of Public Health, University of Texas Health Sciences Center at Houston, Houston, TX, United States
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Shin DW, Chun S, Kim YI, Kim SJ, Kim JS, Chong S, Park YS, Song SY, Lee JH, Ahn HK, Kim EY, Yang SH, Lee MK, Cho DG, Jang TW, Son JW, Ryu JS, Cho MJ. A national survey of lung cancer specialists' views on low-dose CT screening for lung cancer in Korea. PLoS One 2018; 13:e0192626. [PMID: 29420619 PMCID: PMC5805325 DOI: 10.1371/journal.pone.0192626] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 01/26/2018] [Indexed: 12/18/2022] Open
Abstract
Lung cancer specialists play an important role in designing and implementing lung cancer screening. We aimed to describe their 1) attitudes toward low-dose lung computed tomography (LDCT) screening, 2) current practices and experiences of LDCT screening and 3) attitudes and opinions towards national lung cancer screening program (NLCSP). We conducted a national web-based survey of pulmonologists, thoracic surgeons, medical oncologists, and radiological oncologists who are members of Korean Association for Lung Cancer (N = 183). Almost all respondents agreed that LDCT screening increases early detection (100%), improves survival (95.1%), and gives a good smoking cessation counseling opportunity (88.6%). Most were concerned about its high false positive results (79.8%) and the subsequent negative effects. Less than half were concerned about radiation hazard (37.2%). Overall, most (89.1%) believed that the benefits outweigh the risks and harms. Most (79.2%) stated that they proactively recommend LDCT screening to those who are eligible for the current guidelines, but the screening propensity varied considerably. The majority (77.6%) agreed with the idea of NLCSP and its beneficial effect, but had concerns about the quality control of CT devices (74.9%), quality assurance of radiologic interpretation (63.3%), poor access to LDCT (56.3%), and difficulties in selecting eligible population using self-report history (66.7%). Most (79.2%) thought that program need to be funded by a specialized fund rather than by the National Health Insurance. The opinions on the level of copayment for screening varied. Our findings would be an important source for health policy decision when considering for NLCSP in Korea.
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Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Department of digital health, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Sohyun Chun
- International Clinic, Samsung Medical Center, Seoul, Korea
| | - Young Il Kim
- Department of Radiation Oncology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Seung Joon Kim
- Department of Internal Medicine, Seoul St. Mary Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jung Soo Kim
- Department of Internal Medicine, lnha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - SeMin Chong
- Department of Radiology, Chung-Ang University Medical Center, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young Sik Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang-Yun Song
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Jin Han Lee
- Medical Correspondent & Social Policy Desk, Donga-A Ilbo, Seoul, Korea
| | - Hee Kyung Ahn
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Eun Young Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Sei Hoon Yang
- Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Korea
| | - Myoung Kyu Lee
- Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Deog Gon Cho
- Department of Thoracic and Cardiovascular Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Tae Won Jang
- Department of Internal Medicine, Kosin University Medical College, Pusan, Korea
| | - Ji Woong Son
- Department of Internal Medicine, Konyang University Hospital, Daejeon, Korea
| | - Jeong-Seon Ryu
- Department of Internal Medicine, lnha University Hospital, Inha University College of Medicine, Incheon, Korea
- * E-mail:
| | - Moon-June Cho
- Department of Radiation Oncology, Chungnam National University School of Medicine, Daejeon, Korea
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11
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Henderson LM, Jones LM, Marsh MW, Brenner AT, Goldstein AO, Benefield TS, Greenwood-Hickman MA, Molina PL, Rivera MP, Reuland DS. Opinions, practice patterns, and perceived barriers to lung cancer screening among attending and resident primary care physicians. Risk Manag Healthc Policy 2018; 10:189-195. [PMID: 29403320 PMCID: PMC5784747 DOI: 10.2147/rmhp.s143152] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The US Preventive Services Task Force recommended annual lung cancer screening with low-dose computed tomography (LDCT) for high-risk patients in December 2013. We compared lung cancer screening-related opinions and practices among attending and resident primary care physicians (PCPs). Methods In 2015, we conducted a 23-item survey among physicians at a large academic medical center. We surveyed 100 resident PCPs (30% response rate) and 86 attending PCPs (49% response rate) in Family Medicine and Internal Medicine. The questions focused on physicians’ opinions, knowledge of recommendations, self-reported practice patterns, and barriers to lung cancer screening. In 2015 and 2016, we compared responses among attending versus resident PCPs using chi-square/Fisher’s exact tests and 2-samples t-tests. Results Compared with resident PCPs, attending PCPs were older (mean age =47 vs 30 years) and more likely to be male (54% vs 37%). Over half of both groups concurred that inconsistent recommendations make deciding whether or not to screen difficult. A substantial proportion in both groups indicated that they were undecided about the benefit of lung cancer screening for patients (43% attending PCPs and 55% resident PCPs). The majority of attending and resident PCPs agreed that barriers to screening included limited time during patient visits (62% and 78%, respectively), cost to patients (74% and 83%, respectively), potential for complications (53% and 70%, respectively), and a high false-positive rate (67% and 73%, respectively). Conclusion There was no evidence to suggest that attending and resident PCPs had differing opinions about lung cancer screening. For population-based implementation of lung cancer screening, physicians and trainees will need resources and time to address the benefits and harms with their patients.
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Affiliation(s)
- Louise M Henderson
- Department of Radiology, The University of North Carolina, Chapel Hill, NC
| | - Laura M Jones
- Department of Radiology, The University of North Carolina, Chapel Hill, NC
| | - Mary W Marsh
- Department of Radiology, The University of North Carolina, Chapel Hill, NC
| | - Alison T Brenner
- Department of Medicine.,The University of North Carolina Lineberger Comprehensive Cancer Center
| | - Adam O Goldstein
- Department of Family Medicine, The University of North Carolina, Chapel Hill, NC
| | - Thad S Benefield
- Department of Radiology, The University of North Carolina, Chapel Hill, NC
| | | | - Paul L Molina
- Department of Radiology, The University of North Carolina, Chapel Hill, NC
| | | | - Daniel S Reuland
- Department of Medicine.,The University of North Carolina Lineberger Comprehensive Cancer Center
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12
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Khairy M, Duong DK, Shariff-Marco S, Cheng I, Jain J, Balakrishnan A, Liu L, Gupta A, Chandramouli R, Hsing A, Leung A, Singh B, Nair VS. An Analysis of Lung Cancer Screening Beliefs and Practice Patterns for Community Providers Compared to Academic Providers. Cancer Control 2018; 25:1073274818806900. [PMID: 30375235 PMCID: PMC6210633 DOI: 10.1177/1073274818806900] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/19/2018] [Accepted: 08/30/2018] [Indexed: 11/16/2022] Open
Abstract
Despite guidelines recommending annual low-dose computed tomography (LDCT) screening for lung cancer, uptake remains low due to the perceived complexity of initiating and maintaining a clinical program-problems that likely magnify in underserved populations. We conducted a survey of community providers at Federally Qualified Health Centers (FQHCs) in Santa Clara County, California, to evaluate provider-related factors that affect adherence. We then compared these findings to academic providers' (APs) LDCT screening knowledge, behaviors, and attitudes at an academic referral center in the same county. The 4 FQHCs enrolled care for 80 000 patients largely of minority descent and insured by Medi-Cal. Of the 75 FQHC providers (FQHCPs), 36 (48%) completed the survey. Of the 36 providers, 8 (22%) knew screening criteria. Fifteen (42%) FQHCPs discussed LDCT screening with patients. Compared to 36 APs, FQHCPs were more concerned about harms, false positives, discussion time, patient apathy, insurance coverage, and a lack of expertise for screening and follow-up. Yet, more FQHCPs thought screening was effective (27 [75%] of 36) compared to APs ( P = .0003). In conclusion, provider knowledge gaps are greater and barriers are different for community clinics caring for underserved populations compared to their academic counterparts, but practical and scalable solutions exist to enhance adoption.
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Affiliation(s)
- Marjon Khairy
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
- * Marjon Khairy and Duy K. Duong are equal contributors and co-primary authors
| | - Duy K. Duong
- Division of Pulmonary & Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA
- * Marjon Khairy and Duy K. Duong are equal contributors and co-primary authors
| | | | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Jennifer Jain
- Cancer Prevention Institute of California, Fremont, CA, USA
| | | | - Lynn Liu
- North East Medical Center, San Jose, CA, USA
| | - Aarti Gupta
- Mayview Community Health Center, Mountain View, CA, USA
| | | | - Ann Hsing
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Ann Leung
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Baldeep Singh
- Department of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA, USA
| | - Viswam S. Nair
- Division of Pulmonary & Critical Care Medicine, USF Health Morsani College of Medicine, Tampa, FL, USA
- Thoracic Oncology Program, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Tampa, FL, USA
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13
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O'Brien MA, Sullivan F, Carson A, Siddiqui R, Syed S, Paszat L. Piloting electronic screening forms in primary care: findings from a mixed methods study to identify patients eligible for low dose CT lung cancer screening. BMC FAMILY PRACTICE 2017; 18:95. [PMID: 29179686 PMCID: PMC5704529 DOI: 10.1186/s12875-017-0666-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 11/16/2017] [Indexed: 11/10/2022]
Abstract
Background Recent evidence suggests that screening with low dose computed tomography (LDCT) scans significantly reduces mortality from lung cancer. However, optimal methods to identify potentially eligible patients in primary care are not known. Using brief electronic screening forms administered prior to a primary care visit is a strategy to identify high risk, asymptomatic patients eligible for LDCT screening. The objective of this study was to compare the acceptability and feasibility of using brief electronic versus paper screening forms to identify eligible patients at high risk of developing lung cancer in primary care. Methods A mixed method pilot comparative study was conducted in primary care. Practices were allocated to an electronic form (e-form) group or a paper-based form (p-form) group. Allocation was randomly assigned for the first practice then by alternation. Patients in the e-form practices completed forms at home via the web or in the waiting room on a tablet. Patients in p-form practices completed forms in waiting rooms. Interviews were conducted with patients, administrators, and primary care physicians (PCPs) about their experiences. Results Six of 30 (20%) eligible practices agreed to participate. Over the 16-week study period, a total of 831 of an expected 1442 patients (58%) aged 55–74 years were enrolled; 573/690 (83%) patients in the e-form group and 258/752 (34%) in the p-form group. Of the 573 participants in the e-form group, 335 (58%) completed forms via the web; 238 (29%) did so via tablet. Twenty-four interviews were conducted with 15 patients, 5 administrative staff and 4 PCPs. Patients were willing to discuss lung cancer screening eligibility with their PCP. Staff members expressed low administrative burden except for an extra step to link appointment information to patient demographics to identify eligible patients. PCPs indicated that forms were reminders to discuss smoking cessation. PCPs in the e-form group reported that patients asked questions about screening. Conclusion There was fairly low uptake by primary care practices. For e-forms to be feasible in practice workflow, electronic medical record software needs to link appointment information with patient eligibility requirements. The use of brief pre-consultation electronic screening forms for LDCT eligibility encouraged PCPs to discuss smoking cessation with patients.
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Affiliation(s)
- Mary Ann O'Brien
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Fifth Floor, Toronto, ON, M5G 1V7, Canada.
| | - Frank Sullivan
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Fifth Floor, Toronto, ON, M5G 1V7, Canada.,North York General Hospital, Toronto, ON, Canada.,Medical School, University of St Andrews, Scotland, UK.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Andrea Carson
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Fifth Floor, Toronto, ON, M5G 1V7, Canada
| | - Rabiya Siddiqui
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Fifth Floor, Toronto, ON, M5G 1V7, Canada
| | - Saddaf Syed
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Fifth Floor, Toronto, ON, M5G 1V7, Canada
| | - Lawrence Paszat
- Sunnybrook Research Institute, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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14
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Gressard L, DeGroff AS, Richards TB, Melillo S, Kish-Doto J, Heminger CL, Rohan EA, Allen KG. A qualitative analysis of smokers' perceptions about lung cancer screening. BMC Public Health 2017; 17:589. [PMID: 28637439 PMCID: PMC5479014 DOI: 10.1186/s12889-017-4496-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 06/12/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND In 2013, the US Preventive Services Task Force (USPSTF) began recommending lung cancer screening for high risk smokers aged 55-80 years using low-dose computed tomography (CT) scan. In light of these updated recommendations, there is a need to understand smokers' knowledge of and experiences with lung cancer screening in order to inform the design of patient education and tobacco cessation programs. The purpose of this study is to describe results of a qualitative study examining smokers' perceptions around lung cancer screening tests. METHODS In 2009, prior to the release of the updated USPSTF recommendations, we conducted 12 120-min, gender-specific focus groups with 105 current smokers in Charlotte, North Carolina and Cincinnati, Ohio. Focus group facilitators asked participants about their experience with three lung cancer screening tests, including CT scan, chest x-ray, and sputum cytology. Focus group transcripts were transcribed and qualitatively analyzed using constant comparative methods. RESULTS Participants were 41-67 years-old, with a mean smoking history of 38.9 pack-years. Overall, 34.3% would meet the USPSTF's current eligibility criteria for screening. Most participants were unaware of all three lung cancer screening tests. The few participants who had been screened recalled limited information about the test. Nevertheless, many participants expressed a strong desire to pursue lung cancer screening. Using the social ecological model for health promotion, we identified potential barriers to lung cancer screening at the 1) health care system level (cost of procedure, confusion around results), 2) cultural level (fatalistic beliefs, distrust of medical system), and 3) individual level (lack of knowledge, denial of risk, concerns about the procedure). Although this study was conducted prior to the updated USPSTF recommendations, these findings provide a baseline for future studies examining smokers' perceptions of lung cancer screening. CONCLUSION We recommend clear and patient-friendly educational tools to improve patient understanding of screening risks and benefits and the use of best practices to help smokers quit. Further qualitative studies are needed to assess changes in smokers' perceptions as lung cancer screening with CT scan becomes more widely used in community practice.
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Affiliation(s)
- Lindsay Gressard
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS F-76, Atlanta, GA 30341-3717 USA
| | - Amy S. DeGroff
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS F-76, Atlanta, GA 30341-3717 USA
| | - Thomas B. Richards
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS F-76, Atlanta, GA 30341-3717 USA
| | - Stephanie Melillo
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS F-76, Atlanta, GA 30341-3717 USA
| | | | | | - Elizabeth A. Rohan
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS F-76, Atlanta, GA 30341-3717 USA
| | - Kristine Gabuten Allen
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS F-76, Atlanta, GA 30341-3717 USA
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15
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Duong DK, Shariff-Marco S, Cheng I, Naemi H, Moy LM, Haile R, Singh B, Leung A, Hsing A, Nair VS. Patient and primary care provider attitudes and adherence towards lung cancer screening at an academic medical center. Prev Med Rep 2017; 6:17-22. [PMID: 28210538 PMCID: PMC5304233 DOI: 10.1016/j.pmedr.2017.01.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 01/18/2017] [Accepted: 01/22/2017] [Indexed: 12/17/2022] Open
Abstract
Low dose CT (LDCT) for lung cancer screening is an evidence-based, guideline recommended, and Medicare approved test but uptake requires further study. We therefore conducted patient and provider surveys to elucidate factors associated with utilization. Patients referred for LDCT at an academic medical center were questioned about their attitudes, knowledge, and beliefs on lung cancer screening. Adherent patients were defined as those who met screening eligibility criteria and completed a LDCT. Referring primary care providers within this same medical system were surveyed in parallel about their practice patterns, attitudes, knowledge and beliefs about screening. Eighty patients responded (36%), 48 of whom were adherent. Among responders, non-Hispanic patients (p = 0.04) were more adherent. Adherent respondents believed that CT technology is accurate and early detection is useful, and they trusted their providers. A majority of non-adherent patients (79%) self-reported an intention to obtain a LDCT in the future. Of 36 of 87 (41%) responding providers, only 31% knew the correct lung cancer screening eligibility criteria, which led to a 37% inappropriate referral rate from 2013 to 2015. Yet, 75% had initiated lung cancer screening discussions, 64% thought screening was at least moderately effective, and 82% were interested in learning more of the 33 providers responding to these questions. Overall, patients were motivated and providers engaged to screen for lung cancer by LDCT. Non-adherent patient “procrastinators” were motivated to undergo screening in the future. Additional follow through on non-adherence may enhance screening uptake, and raising awareness for screening eligibility through provider education may reduce inappropriate referrals. Lung cancer screening was viewed favorably by patients at our medical center. Non-Hispanic patients were more likely to adhere to a prescribed screening test. Eligible, non-adherent, patients were still interested in screening. Providers were motivated to screen but under-informed on patient eligibility. Providers were open to additional education on lung cancer screening.
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Affiliation(s)
- Duy K Duong
- Santa Clara Valley Medical Center, Department of Medicine, San Jose, CA, United States; Stanford University School of Medicine, Division of Pulmonary & Critical Care Medicine, Stanford, CA, United States
| | - Salma Shariff-Marco
- Cancer Prevention Institute of California, Fremont, CA, United States; Stanford Cancer Institute, Stanford, CA, United States
| | - Iona Cheng
- Cancer Prevention Institute of California, Fremont, CA, United States; Stanford Cancer Institute, Stanford, CA, United States
| | - Harris Naemi
- Stanford University School of Medicine, Department of Radiology, Stanford, CA, United States; Stanford University School of Medicine, Division of Pulmonary & Critical Care Medicine, Stanford, CA, United States
| | - Lisa M Moy
- Cancer Prevention Institute of California, Fremont, CA, United States
| | - Robert Haile
- Stanford University School of Medicine, Department of Health & Research Policy, Stanford, CA, United States
| | - Baldeep Singh
- Stanford University School of Medicine, Department of General Medical Disciplines, Stanford, CA, United States
| | - Ann Leung
- Stanford University School of Medicine, Department of Radiology, Stanford, CA, United States
| | - Ann Hsing
- Stanford Cancer Institute, Stanford, CA, United States; Stanford University School of Medicine, Stanford Prevention Research Center, Stanford, CA, United States
| | - Viswam S Nair
- Stanford University School of Medicine, Department of Radiology, Stanford, CA, United States; Stanford University School of Medicine, Division of Pulmonary & Critical Care Medicine, Stanford, CA, United States
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16
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Ersek JL, Eberth JM, McDonnell KK, Strayer SM, Sercy E, Cartmell KB, Friedman DB. Knowledge of, attitudes toward, and use of low-dose computed tomography for lung cancer screening among family physicians. Cancer 2016; 122:2324-31. [PMID: 27294476 DOI: 10.1002/cncr.29944] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/08/2016] [Accepted: 01/12/2016] [Indexed: 12/17/2022]
Abstract
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 study was to assess the knowledge of, attitudes toward, and use of LDCT screening for lung cancer among family physicians. METHODS A 32-item questionnaire was distributed to members of the South Carolina Academy of Family Physicians in 2015. Descriptive statistics were calculated. RESULTS There were 101 respondents, and most had incorrect knowledge about which organizations recommended screening. Many physicians continued to recommend CXR for lung cancer screening. Most felt that LDCT screening increased the odds of detecting disease at earlier stages (98%) and that the benefits outweighed the harms (75%). Concerns included unnecessary procedures (88%), stress/anxiety (52%), and radiation exposure (50%). Most physicians discussed the risks/benefits of screening with their patients in some capacity (76%); however, more than 50% reported making 1 or no screening recommendations in the past year. CONCLUSIONS Most family physicians report discussing LDCT with patients at high risk for lung cancer; however, referrals remain low. There are gaps in physician knowledge about screening guidelines and reimbursement, and this indicates a need for further educational outreach. The development of decision aids may facilitate shared decision-making discussions about screening, and targeted interventions may improve knowledge gaps. Cancer 2016;122:2324-2331. © 2016 American Cancer Society.
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Affiliation(s)
- Jennifer L Ersek
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | | | - Scott M Strayer
- Department of Family Medicine, University of South Carolina, Columbia, South Carolina
| | - Erica Sercy
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Kathleen B Cartmell
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Daniela B Friedman
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, South Carolina
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17
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Abstract
We examined the readiness of primary care clinicians to implement lung cancer screening programs in their practice settings in light of recent policy changes in the U.S. Attendees of two large continuing medical education events in Texas held in October and November of 2014 completed surveys about their current lung cancer screening practices and implementation needs. Surveys were completed by 350 participants (57.2% of registered attendees). Although 89.5% of participants routinely screened their patients for tobacco use, only 10.1% had a formal lung cancer screening program in their practice. More than half (56.0%) planned to refer eligible patients for lung cancer screening, 35.6% were not sure, and 8.3% did not plan to refer. Priority areas for implementing lung cancer screening programs in their settings included 1) greater clarity about coverage by private insurance and Medicare, 2) information about available screening centers offering low-dose computed tomography, 3) patient education and shared decision-making tools, 4) implementation toolkits and training for clinic staff, 5) integrating screening programs in electronic health records, and 6) more clarity about clinical guidelines. Practical needs related to identifying eligible patients, referral to screening centers, and tools for shared decision-making must be addressed before lung cancer screening can be implemented on a national scale.
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Affiliation(s)
- Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lewis E Foxhall
- Division of Cancer Prevention & Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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18
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Hoffman RM, Sussman AL, Getrich CM, Rhyne RL, Crowell RE, Taylor KL, Reifler EJ, Wescott PH, Murrietta AM, Saeed AI, Mishra SI. Attitudes and Beliefs of Primary Care Providers in New Mexico About Lung Cancer Screening Using Low-Dose Computed Tomography. Prev Chronic Dis 2015; 12:E108. [PMID: 26160294 PMCID: PMC4509091 DOI: 10.5888/pcd12.150112] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION On the basis of results from the National Lung Screening Trial (NLST), national guidelines now recommend using low-dose computed tomography (LDCT) to screen high-risk smokers for lung cancer. Our study objective was to characterize the knowledge, attitudes, and beliefs of primary care providers about implementing LDCT screening. METHODS We conducted semistructured interviews with primary care providers practicing in New Mexico clinics for underserved minority populations. The interviews, conducted from February through September 2014, focused on providers' tobacco cessation efforts, lung cancer screening practices, perceptions of NLST and screening guidelines, and attitudes about informed decision making for cancer screening. Investigators iteratively reviewed transcripts to create a coding structure. RESULTS We reached thematic saturation after interviewing 10 providers practicing in 6 urban and 4 rural settings; 8 practiced at federally qualified health centers. All 10 providers promoted smoking cessation, some screened with chest x-rays, and none screened with LDCT. Not all were aware of NLST results or current guideline recommendations. Providers viewed study results skeptically, particularly the 95% false-positive rate, the need to screen 320 patients to prevent 1 lung cancer death, and the small proportion of minority participants. Providers were uncertain whether New Mexico had the necessary infrastructure to support high-quality screening, and worried about access barriers and financial burdens for rural, underinsured populations. Providers noted the complexity of discussing benefits and harms of screening and surveillance with their patient population. CONCLUSION Providers have several concerns about the feasibility and appropriateness of implementing LDCT screening. Effective lung cancer screening programs will need to educate providers and patients to support informed decision making and to ensure that high-quality screening can be efficiently delivered in community practice.
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Affiliation(s)
- Richard M Hoffman
- University of New Mexico School of Medicine, University of New Mexico Cancer Center, Albuquerque Veterans Affairs Medical Center, Albuquerque, New Mexico
| | - Andrew L Sussman
- University of New Mexico Cancer Center and Department of Family Medicine and Community Medicine, Albuquerque, New Mexico
| | | | - Robert L Rhyne
- University of New Mexico Cancer Center and Department of Family Medicine and Community Medicine, Albuquerque, New Mexico
| | - Richard E Crowell
- University of New Mexico School of Medicine and University of New Mexico Cancer Center, Albuquerque, New Mexico
| | - Kathryn L Taylor
- Georgetown Lombardi Comprehensive Cancer Center and Georgetown University Medical Center, Washington, DC
| | | | | | - Ambroshia M Murrietta
- Clinical and Translational Science Center, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Ali I Saeed
- University of New Mexico School of Medicine and University of New Mexico Cancer Center, Albuquerque, New Mexico
| | - Shiraz I Mishra
- Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM 87131. . Dr Mishra is also affiliated with the University of New Mexico Cancer Center and the Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
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19
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Elstad EA, Sutkowi-Hemstreet A, Sheridan SL, Vu M, Harris R, Reyna VF, Rini C, Earp JA, Brewer NT. Clinicians' perceptions of the benefits and harms of prostate and colorectal cancer screening. Med Decis Making 2015; 35:467-76. [PMID: 25637592 DOI: 10.1177/0272989x15569780] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 12/19/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Clinicians' perceptions of screening benefits and harms influence their recommendations, which in turn shape patients' screening decisions. We sought to understand clinicians' perceptions of the benefits and harms of cancer screening by comparing 2 screening tests that differ in their balance of potential benefits to harms: colonoscopy, which results in net benefit for many adults, and prostate-specific antigen (PSA) testing, which may do more harm than good. METHODS In this cross-sectional study, 126 clinicians at 24 family/internal medicine practices completed surveys in which they listed and rated the magnitude of colonoscopy and PSA testing benefits and harms for a hypothetical 70-year-old male patient and then estimated the likelihood that these tests would cause harm and lengthen the life of 100 similar men in the next 10 years. We tested the hypothesis that the availability heuristic would explain the association of screening test to perceived likelihood of benefit/harm and a competing hypothesis that clinicians' gist of screening tests as good or bad would mediate this association. RESULTS Clinicians perceived PSA testing to have a greater likelihood of harm and a lower likelihood of lengthening life relative to colonoscopy. Consistent with our gist hypothesis, these associations were mediated by clinicians' gist of screening (balance of perceived benefits to perceived harms). LIMITATIONS Generalizability beyond academic clinicians remains to be established. CONCLUSIONS Targeting clinicians' gist of screening, for example through graphical displays that allow clinicians to make gist-based relative magnitude comparisons, may influence their risk perception and possibly reduce overrecommendation of screening.
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Affiliation(s)
- Emily A Elstad
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC (EAE, CR, JAE, NTB),Cecil B. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC (EAE, ASH, SLS, MV, RH)
| | - Anne Sutkowi-Hemstreet
- Cecil B. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC (EAE, ASH, SLS, MV, RH)
| | - Stacey L Sheridan
- Cecil B. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC (EAE, ASH, SLS, MV, RH),Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC (SLS, MV),Health Care and Prevention Program, University of North Carolina, Chapel Hill, NC (SLS, RH),Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, NC (SLS, RH)
| | - Maihan Vu
- Cecil B. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC (EAE, ASH, SLS, MV, RH),Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC (SLS, MV)
| | - Russell Harris
- Cecil B. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC (EAE, ASH, SLS, MV, RH),Health Care and Prevention Program, University of North Carolina, Chapel Hill, NC (SLS, RH),Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, NC (SLS, RH)
| | - Valerie F Reyna
- College of Human Ecology, Cornell University, Ithaca, NY (VFR)
| | - Christine Rini
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC (EAE, CR, JAE, NTB),Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (CR, NTB)
| | - Jo Anne Earp
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC (EAE, CR, JAE, NTB)
| | - Noel T Brewer
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC (EAE, CR, JAE, NTB),Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC (CR, NTB)
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Klabunde CN, Willis GB, Casalino LP. Facilitators and Barriers to Survey Participation by Physicians. Eval Health Prof 2013; 36:279-95. [DOI: 10.1177/0163278713496426] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Surveys of health care providers are a well-established tool for obtaining information about the organization and delivery of care as well as about provider knowledge and attitudes. However, declining response rates to provider surveys are a widely acknowledged concern. Although a number of studies have identified specific methods for increasing response rates in health care provider—and particularly physician—surveys, few have addressed the more fundamental question of what motivates or deters providers from survey participation. We briefly review theoretical perspectives concerning why providers choose to participate in surveys, and what is known about facilitators and barriers to participation. We then describe several research designs (i.e., focus groups, key informant interviews, diary and office workflow studies, surveying the surveyors, and follow-back studies of respondents/nonrespondents) for obtaining empirical data on facilitators and barriers to survey participation, particularly by physicians and medical groups. Researchers must begin to build an evidence base for understanding provider decisions concerning survey participation.
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Affiliation(s)
- Carrie N. Klabunde
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Gordon B. Willis
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Lawrence P. Casalino
- Department of Public Health, Division of Outcomes and Effectiveness Research, Weill Cornell Medical College, New York, NY, USA
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Aberle DR, Abtin F, Brown K. Computed tomography screening for lung cancer: has it finally arrived? Implications of the national lung screening trial. J Clin Oncol 2013; 31:1002-8. [PMID: 23401434 DOI: 10.1200/jco.2012.43.3110] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The National Lung Screening Trial (NLST) has provided compelling evidence of the efficacy of lung cancer screening using low-dose helical computed tomography (LDCT) to reduce lung cancer mortality. The NLST randomized 53,454 older current or former heavy smokers to receive LDCT or chest radiography (CXR) for three annual screens. Participants were observed for a median of 6.5 years for outcomes. Vital status was available in more than 95% of participants. LDCT was positive in 24.2% of screens, compared with 6.9% of CXRs; more than 95% of all positive LDCT screens were not associated with lung cancer. LDCT detected more than twice the number of early-stage lung cancers and resulted in a stage shift from advanced to early-stage disease. Complications of LDCT screening were minimal. Lung cancer-specific mortality was reduced by 20% relative to CXR; all-cause mortality was reduced by 6.7%. The major harms of LDCT are radiation exposure, high false-positive rates, and the potential for overdiagnosis. This review discusses the risks and benefits of LDCT screening as well as an approach to LDCT implementation that incorporates systematic screening practice with smoking cessation programs and offers opportunities for better determination of appropriate risk cohorts for screening and for better diagnostic prediction of lung cancer in the setting of screen-detected nodules. The challenges of implementation are considered for screening programs, for primary care clinicians, and across socioeconomic strata. Considerations for future research to complement imaging-based screening to reduce the burden of lung cancer are discussed.
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Affiliation(s)
- Denise R Aberle
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90024, USA.
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Slatore CG, Gould MK, Au DH, Deffebach ME, White E. Lung cancer stage at diagnosis: Individual associations in the prospective VITamins and lifestyle (VITAL) cohort. BMC Cancer 2011; 11:228. [PMID: 21649915 PMCID: PMC3129325 DOI: 10.1186/1471-2407-11-228] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 06/07/2011] [Indexed: 12/21/2022] Open
Abstract
Background Lung cancer is the leading cause of cancer death in the United States. Identifying factors associated with stage of diagnosis can improve our understanding of biologic and behavioral pathways of lung cancer development and detection. We used data from a prospective cohort study to evaluate associations of demographic, health history, and health behaviors with early versus late stage at diagnosis of non-small cell lung cancer (NSCLC). Methods We calculated odds ratios (ORs) for the association of patient-level characteristics with advanced stage of diagnosis for NSCLC. The OR's were then adjusted for age, gender, race/ethnicity, smoking status, income, education, chronic obstructive pulmonary disease, and a comorbidity index. Results We identified 612 cases of NSCLC among 77,719 adults, aged 50 to 76 years from Washington State recruited in 2000-2002, with followup through December 2007. In univariate analyses, subjects who quit smoking <10 years (OR 2.56, 95% CI 1.17 - 5.60) and were college graduates (OR 1.67, 95% CI, 1.00 - 2.76) had increased risks of being diagnosed with advanced stage NSCLC, compared to never smokers and non-college graduates, respectively. Receipt of sigmoidoscopy/colonoscopy, compared to no receipt, was associated with a decreased risk of advanced stage (OR 0.65, 95% CI, 0.43 - 0.99). The adjusted OR for receipt of sigmoidoscopy/colonoscopy was 0.55 (95% CI, 0.36 - 0.86). There was evidence that increasing the number of screening activities was associated with a decreased risk of advanced stage NSCLC (P for trend = 0.049). Conclusions Smoking status, education, and a screening activity were associated with stage at diagnosis of NSCLC. These results may guide future studies of the underlying mechanisms that influence how NSCLC is detected and diagnosed.
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Affiliation(s)
- Christopher G Slatore
- Portland VA Medical Center, Health Services Research & Development, Portland, OR, USA.
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