1
|
Luo Z, Guo W, Zhou H, Chen Z. Knowledge, attitude, and practice toward lung cancer risk among offspring of lung cancer patients: a cross-sectional study. Sci Rep 2024; 14:18003. [PMID: 39097631 PMCID: PMC11297909 DOI: 10.1038/s41598-024-69142-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 08/01/2024] [Indexed: 08/05/2024] Open
Abstract
Lung cancer is intricately associated with genetic susceptibility, leading to familial clustering among affected individuals. This cross-sectional study aimed to assess the knowledge, attitude, and practice (KAP) toward lung cancer risk among the offspring of lung cancer patients. This study was conducted at Guangdong Provincial People's Hospital between April 2023 and August 2023. Participants' demographic characteristics and KAP toward lung cancer risk were collected through questionnaires. A total of 481 valid questionnaires were enrolled, with 243 (50.52%) males, and 242 (50.31%) aged > 40 years old. The mean scores for knowledge, attitude, and practice were 8.54 ± 2.60 (range: 0-13), 25.93 ± 3.16 (range: 7-35), and 17.47 ± 4.30 (range: 5-25), respectively. Structural equation modeling indicated that knowledge exerted a negative direct effect on attitude (β = - 0.417, P = 0.006) but a positive direct effect on practice (β = 0.733, P = 0.025). Additionally, attitudes displayed a negative direct effect on practice (β = - 1.707, P = 0.002). In conclusion, offspring of lung cancer patients exhibited insufficient knowledge, positive attitude, and suboptimal practice toward lung cancer risk.
Collapse
Affiliation(s)
- Zeru Luo
- Department of Geriatric Respiratory, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangdong Provincial Geriatrics Institute, Southern Medical University, No. 106, Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China.
| | - Weihong Guo
- Department of Respiratory, Zhongshan City People's Hospital, Zhongshan, 528400, Guangdong, China
| | - Haiyu Zhou
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, Guangdong, China
| | - Zixing Chen
- Department of Geriatric Respiratory, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangdong Provincial Geriatrics Institute, Southern Medical University, No. 106, Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| |
Collapse
|
2
|
Marcotte LM, Khor S, Flum DR, Akinsoto N, Chaudhari V, Wood DE, Lavallee DC, Triplette M, Farjah F. Factors associated with lung cancer risk factor documentation. THE AMERICAN JOURNAL OF MANAGED CARE 2023; 29:439-447. [PMID: 37428463 PMCID: PMC10761004 DOI: 10.37765/ajmc.2023.89354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Objectives To identify factors associated with the minimum necessary information to determine an individual’s eligibility for lung cancer screening (ie, sufficient risk factor documentation) and to characterize clinic-level variability in documentation. Study Design Cross-sectional observational study using electronic health record data from an academic health system in 2019. Methods We calculated the relative risk of sufficient lung cancer risk factor documentation by patient-, provider-, and system-level variables using Poisson regression models, clustering by clinic. We compared unadjusted, risk-adjusted, and reliability-adjusted proportions of patients with sufficient smoking documentation across 31 clinics using logistic regression models and 2-level hierarchical logit models to estimate reliability-adjusted proportions across clinics. Results Among 20,632 individuals, 60% had sufficient risk factor documentation to determine screening eligibility. Patient-level factors inversely associated with risk factor documentation included Black race (relative risk [RR], 0.70; 95% CI, 0.60-0.81), non-English preferred language (RR, 0.60; 95% CI, 0.49-0.74), Medicaid insurance (RR, 0.64; 95% CI, 0.57-0.71), and nonactivated patient portal (RR, 0.85; 95% CI, 0.80-0.90). Documentation varied across clinics. The reliability-adjusted intraclass correlation coefficient decreased from 11.0% (95% CI, 6.9%-17.1%) to 5.3% (95% CI, 3.2%-8.6%), adjusting for covariates. Conclusions We found a low rate of sufficient lung cancer risk factor documentation and associations of risk factor documentation based on patient-level factors such as race, insurance status, language, and patient portal activation. Risk factor documentation rates varied across clinics, and only approximately half the variation was explained by factors in our analysis.
Collapse
Affiliation(s)
- Leah M Marcotte
- Department of Medicine, University of Washington School of Medicine, 4245 Roosevelt Way NE, Seattle, WA 98105.
| | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Smith L, Williams RM, Whealan J, Windels A, Anderson ED, Parikh V, Breece CJ, Puran N, Shepherd AK, Geronimo M, Luta G, Adams-Campbell L, Taylor KL. Development and Evaluation of Brief Web-Based Education for Primary Care Providers to Address Inequities in Lung Cancer Screening and Smoking Cessation Treatment. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1296-1303. [PMID: 36637713 PMCID: PMC10754418 DOI: 10.1007/s13187-023-02262-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/01/2023] [Indexed: 06/17/2023]
Abstract
Annual lung cancer screening (LCS) is recommended for individuals at high risk for lung cancer. However, primary care provider-initiated discussions about LCS and referrals for screening are low overall, particularly among Black or African Americans and other minoritized racial and ethnic groups. Disparities also exist in receiving provider advice to quit smoking. Effective methods are needed to improve provider knowledge about LCS and tobacco-related disparities, and to provide resources to achieve equity in LCS rates. We report the feasibility and impact of pairing a self-directed Lung Cancer Health Disparities (HD) Web-based course with the National Training Network Lung Cancer Screening (LuCa) course on primary care providers' knowledge about LCS and the health disparities associated with LCS. In a quasi-experimental study, primary care providers (N = 91) recruited from the MedStar Health System were assigned to complete the LuCa course only vs. the LuCa + HD courses. We measured pre-post-LCS-related knowledge and opinions about the courses. The majority (60.4%) of providers were resident physicians. There was no significant difference between groups on post-test knowledge (p > 0.05). However, within groups, there was an improvement in knowledge from pre- to post-test (LuCa only (p = 0.03); LuCa + HD (p < 0.001)). The majority of providers (81%) indicated they planned to improve their screening and preventive practices after having reviewed the educational modules. These findings provide preliminary evidence that this e-learning course can be used to educate providers on LCS, smoking cessation, and related disparities impacting patients.
Collapse
Affiliation(s)
- Laney Smith
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 2115 Wisconsin Avenue NW, Suite 300, Washington, D.C., 20007‑2401, USA
| | - Randi M Williams
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 2115 Wisconsin Avenue NW, Suite 300, Washington, D.C., 20007‑2401, USA.
| | - Julia Whealan
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 2115 Wisconsin Avenue NW, Suite 300, Washington, D.C., 20007‑2401, USA
| | - Allison Windels
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, D.C., USA
| | - Eric D Anderson
- Department of Interventional Pulmonology, Georgetown University Medical Center, Washington, D.C., USA
| | | | - Chavalia Joan Breece
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, D.C., USA
| | - Namita Puran
- Washington Cancer Institute, MedStar Washington Hospital Center, Washington, D.C., USA
| | - Andrea K Shepherd
- Louise Herrington School of Nursing, Baylor University, Dallas, TX, USA
| | | | - George Luta
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, D.C., 20007, USA
| | - Lucile Adams-Campbell
- Office of Minority Health and Health Disparities Research, Georgetown University Medical Center, Washington, D.C., 20007, USA
| | - Kathryn L Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 2115 Wisconsin Avenue NW, Suite 300, Washington, D.C., 20007‑2401, USA
| |
Collapse
|
4
|
Khouzam MS, Wood DE, Vigneswaran W, Goyal A, Czerlanis C, Blackmon SH, Donington J, Albain KS, Freeman RK, Abdelsattar ZM. Impact of Federal Lung Cancer Screening Policy on the Incidence of Early-stage Lung Cancer. Ann Thorac Surg 2023; 115:827-833. [PMID: 36470567 DOI: 10.1016/j.athoracsur.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/21/2022] [Accepted: 11/07/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND In December 2013 the US Preventative Services Task Force (USPSTF) recommended annual lung cancer screening for high-risk patients. The Centers for Medicare & Medicaid Services (CMS) later announced coverage in 2015. The impact of these federal decisions at the population level is unknown. METHODS Using the Surveillance, Epidemiology, and End Results database, we studied changes in lung cancer incidence by stage and linked to US census data to obtain age-adjusted estimates standardized to the US population. Based on age at diagnosis we stratified patients as age-eligible or age-ineligible for screening. We used difference-in-differences regression to determine the effect of screening on lung cancer incidence by stage. RESULTS For all age groups the incidence of early-stage lung cancer both before and after the USPSTF guidelines remained relatively stable at 12.8 ± 0.52 and 13.5 ± 0.92 per 100,000 patients, respectively (P = .068). However the difference-in-differences analysis estimated an absolute increase in the age-adjusted incidence by 3.4 per 100,000 persons in the age-eligible group after the announcement of the guidelines (P = .007). The effect was even larger after the CMS decision (4.3/100,000 persons, P < .001). Similarly there was a 14.2 per 100,000 persons absolute reduction in the incidence of advanced-stage lung cancer (P < .001). CONCLUSIONS The 2013 USPSTF lung cancer screening guidelines and CMS coverage decisions were associated with an increased incidence of early-stage lung cancer and decreased incidence of advance-staged lung cancer at the population level.
Collapse
Affiliation(s)
- Matthew S Khouzam
- Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Douglas E Wood
- Department of Surgery, University of Washington, Seattle, Washington
| | - Wickii Vigneswaran
- Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois; Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Amit Goyal
- Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois; Department of Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Cheryl Czerlanis
- Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois; Department of Medicine, Loyola University Medical Center, Maywood, Illinois
| | | | - Jessica Donington
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Kathy S Albain
- Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois; Department of Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Richard K Freeman
- Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois; Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Zaid M Abdelsattar
- Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois; Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois.
| |
Collapse
|
5
|
Sedani AE, Davis OC, Clifton SC, Campbell JE, Chou AF. Facilitators and Barriers to Implementation of Lung Cancer Screening: A Framework-Driven Systematic Review. J Natl Cancer Inst 2022; 114:1449-1467. [PMID: 35993616 PMCID: PMC9664175 DOI: 10.1093/jnci/djac154] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/14/2022] [Accepted: 08/15/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The purpose of this study is to undertake a comprehensive systematic review to describe multilevel factors (barriers and facilitators) that may influence the implementation of low-dose chest computed tomography for lung cancer screening in the United States. METHODS Systematic literature searches were performed using 6 online databases and citation indexes for peer-reviewed studies, for articles published from 2013 to 2021. Studies were classified into 3 perspectives, based on the study's unit of analysis: system, health-care provider, and patient. Barriers and facilitators identified for each study included in our final review were then coded and categorized using the Consolidate Framework for Implementation Research domains. RESULTS At the system level, the 2 most common constructs were external policy and incentives and executing the implementation process. At the provider level, the most common constructs were evidence strength and quality of the intervention characteristics, patient needs and resources, implementation climate, and an individual's knowledge and beliefs about the intervention. At the patient level, the most common constructs were patient needs and resources, individual's knowledge and beliefs about the intervention, and engaging in the implementation process. These constructs can act as facilitators or barriers to lung cancer screening implementation. CONCLUSIONS Applying the Consolidate Framework for Implementation Research domains and constructs to understand and specify factors facilitating uptake of lung cancer screening as well as cataloging the lessons learned from previous efforts helps inform the development and implementation processes of lung cancer screening programs in the community setting. REGISTRATION PROSPERO, CRD42021247677.
Collapse
Affiliation(s)
- Ami E Sedani
- Correspondence to: Ami E. Sedani, MPH, Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th Street, Oklahoma City, OK 73104, USA (e-mail: )
| | - Olivia C Davis
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shari C Clifton
- Robert M. Bird Health Sciences Library, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Janis E Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ann F Chou
- Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| |
Collapse
|
6
|
Chen S, Wu S. Deep Q-networks with web-based survey data for simulating lung cancer intervention prediction and assessment in the elderly: a quantitative study. BMC Med Inform Decis Mak 2022; 22:1. [PMID: 34983500 PMCID: PMC8725301 DOI: 10.1186/s12911-021-01695-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/17/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Lung cancer screening and intervention might be important to help detect lung cancer early and reduce the mortality, but little was known about lung cancer intervention strategy associated with intervention effect for preventing lung cancer. We employed Deep Q-Networks (DQN) to respond to this gap. The aim was to quantitatively predict lung cancer optimal intervention strategy and assess intervention effect in aged 65 years and older (the elderly). METHODS We screened lung cancer high risk with web-based survey data and conducted simulative intervention. DQN models were developed to predict optimal intervention strategies to prevent lung cancer in elderly men and elderly women separately. We assessed the intervention effects to evaluate the optimal intervention strategy. RESULTS Proposed DQN models quantitatively predicted and assessed lung cancer intervention. DQN models performed well in five stratified groups (elderly men, elderly women, men, women and the whole population). Stopping smoking and extending quitting smoking time were optimal intervention strategies in elderly men. Extending quitting time and reducing smoked cigarettes number were optimal intervention strategies in elderly women. In elderly men and women, the maximal reductions of lung cancer incidence were 31.81% and 24.62% separately. Lung cancer incidence trend was deduced from the year of 1984 to 2050, which predicted that the difference of lung cancer incidence between elderly men and women might be significantly decreased after thirty years quitting time. CONCLUSIONS We quantitatively predicted optimal intervention strategy and assessed lung cancer intervention effect in the elderly through DQN models. Those might improve intervention effects and reasonably prevent lung cancer.
Collapse
Affiliation(s)
- Songjing Chen
- Institute of Medical Information, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Sizhu Wu
- Institute of Medical Information, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China.
| |
Collapse
|
7
|
Akhtar A, Sosa E, Castro S, Sur M, Lozano V, D'Souza G, Yeung S, Macalintal J, Patel M, Zou X, Wu PC, Silver E, Sandoval J, Gray SW, Reckamp KL, Kim JY, Sun V, Raz DJ, Erhunmwunsee L. A Lung Cancer Screening Education Program Impacts both Referral Rates and Provider and Medical Assistant Knowledge at Two Federally Qualified Health Centers. Clin Lung Cancer 2021; 23:356-363. [PMID: 34991968 DOI: 10.1016/j.cllc.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/12/2021] [Accepted: 12/02/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Federally Qualified Health Centers (FQHCs) serve minority and low-socioeconomic populations and provide care to high-risk smokers. These centers frequently experience barriers, including low provider and medical assistant (MA) knowledge around lung cancer screening (LCS). Subsequent low LCS referral rates by providers at FQHCs limit utilization of LCS in eligible, high-risk, underserved patients. METHODS Providers and MAs from two FQHCs participated in a LCS educational session. A pre-educational survey was administered at the start of the session and a post-educational survey at the end. The intervention included a presentation with education around non-small cell lung cancer, LCS, tobacco cessation, and shared-decision making. Both surveys were used to evaluate changes in provider and MA ability to determine eligible patients for LCS. The Pearson's Chi-squared test with Yates' continuity correction was used to measure the impact. RESULTS A total of 29 providers and 28 MAs enrolled in the study from two FQHCs. There was an improvement, P < .009 and P < .015 respectively, in provider and MA confidence in identifying patients for LCS. Additionally, one year prior to the program, 9 low-dose computed tomography (LDCTs) were ordered at one of the FQHCs and 0 at the other. After the program, over 100 LDCTs were ordered at each FQHC. CONCLUSIONS A targeted LCS educational program improves provider and MAs' ability to identify eligible LCS patients and is associated with an increase in the number of patients referred to LDCT at FQHCs.
Collapse
Affiliation(s)
- Aamna Akhtar
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Ernesto Sosa
- Department of Populations Sciences, City of Hope National Medical Center, Duarte, CA
| | - Samuel Castro
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Melissa Sur
- Department of Populations Sciences, City of Hope National Medical Center, Duarte, CA
| | - Vanessa Lozano
- Department of Populations Sciences, City of Hope National Medical Center, Duarte, CA
| | - Gail D'Souza
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Sophia Yeung
- Department of Nursing, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Jonjon Macalintal
- Department of Nursing, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Meghna Patel
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Xiaoke Zou
- Department of Populations Sciences, City of Hope National Medical Center, Duarte, CA
| | - Pei-Chi Wu
- Herald Christian Health Center, Rosemead, CA
| | | | - Jossie Sandoval
- Department of Medicine, City of Hope Cancer Center, Duarte, CA
| | - Stacy W Gray
- Department of Populations Sciences, City of Hope National Medical Center, Duarte, CA; Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Karen L Reckamp
- Department of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jae Y Kim
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Virginia Sun
- Department of Populations Sciences, City of Hope National Medical Center, Duarte, CA
| | - Dan J Raz
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Loretta Erhunmwunsee
- Department of Surgery, City of Hope National Medical Center, Duarte, CA; Department of Populations Sciences, City of Hope National Medical Center, Duarte, CA.
| |
Collapse
|
8
|
Peterson E, Harris K, Farjah F, Akinsoto N, Marcotte LM. Improving smoking history documentation in the electronic health record for lung cancer risk assessment and screening in primary care: A case study. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2021; 9:100578. [PMID: 34450358 DOI: 10.1016/j.hjdsi.2021.100578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/15/2021] [Accepted: 08/12/2021] [Indexed: 11/30/2022]
Abstract
Improving risk factor documentation in the electronic health record (EHR) is important in order to determine patient eligibility for lung cancer screening. System-level prioritization combined with a clinic-level initiative can improve risk factor documentation rates. Multi-faceted interventions that include training, process improvement, data management, and continuous performance feedback are effective and can be integrated into existing workflows.
Collapse
Affiliation(s)
| | - Kathryn Harris
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Farhood Farjah
- Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Nkem Akinsoto
- Primary Care and Population Health, UW Medicine, Seattle, WA, USA
| | - Leah M Marcotte
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| |
Collapse
|