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Richmond J, Fernandez JR, Bonnet K, Sellers A, Schlundt DG, Forde AT, Wilkins CH, Aldrich MC. Patient Lung Cancer Screening Decisions and Environmental and Psychosocial Factors. JAMA Netw Open 2024; 7:e2412880. [PMID: 38819825 PMCID: PMC11143466 DOI: 10.1001/jamanetworkopen.2024.12880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/17/2024] [Indexed: 06/01/2024] Open
Abstract
Importance Screening for lung cancer using low-dose computed tomography is associated with reduced lung cancer-specific mortality, but uptake is low in the US; understanding how patients make decisions to engage with lung cancer screening is critical for increasing uptake. Prior research has focused on individual-level psychosocial factors, but environmental factors (eg, historical contexts that include experiencing racism) and modifying factors-those that can be changed to make it easier or harder to undergo screening-also likely affect screening decisions. Objective To investigate environmental, psychosocial, and modifying factors influencing lung cancer screening decision-making and develop a conceptual framework depicting relationships between these factors. Design, Setting, and Participants This multimethod qualitative study was conducted from December 2021 to June 2022 using virtual semistructured interviews and 4 focus groups (3-4 participants per group). All participants met US Preventive Services Task Force eligibility criteria for lung cancer screening (ie, age 50-80 years, at least a 20 pack-year smoking history, and either currently smoke or quit within the past 15 years). Screening-eligible US participants were recruited using an online panel. Main Outcomes and Measures Key factors influencing screening decisions (eg, knowledge, beliefs, barriers, and facilitators) were the main outcome. A theory-informed, iterative inductive-deductive approach was applied to analyze data and develop a conceptual framework summarizing results. Results Among 34 total participants (interviews, 20 [59%]; focus groups, 14 [41%]), mean (SD) age was 59.1 (4.8) years and 20 (59%) identified as female. Half had a household income below $20 000 (17 [50%]). Participants emphasized historical and present-day racism as critical factors contributing to mistrust of health care practitioners and avoidance of medical procedures like screening. Participants reported that other factors, such as public transportation availability, also influenced decisions. Additionally, participants described psychosocial processes involved in decisions, such as perceived screening benefits, lung cancer risk appraisal, and fear of a cancer diagnosis or harmful encounters with practitioners. In addition, participants identified modifying factors (eg, insurance coverage) that could make receiving screening easier or harder. Conclusions and Relevance In this qualitative study of patient lung cancer screening decisions, environmental, psychosocial, and modifying factors influenced screening decisions. The findings suggest that systems-level interventions, such as those that help practitioners understand and discuss patients' prior negative health care experiences, are needed to promote effective screening decision-making.
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Affiliation(s)
- Jennifer Richmond
- Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jessica R. Fernandez
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
- NORC at the University of Chicago, Bethesda, Maryland
| | - Kemberlee Bonnet
- Department of Psychology, Vanderbilt University, Nashville, Tennessee
- Qualitative Research Core, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ashley Sellers
- Department of Psychology, Vanderbilt University, Nashville, Tennessee
- Qualitative Research Core, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David G. Schlundt
- Department of Psychology, Vanderbilt University, Nashville, Tennessee
- Qualitative Research Core, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Allana T. Forde
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Consuelo H. Wilkins
- Division of Geriatric Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melinda C. Aldrich
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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2
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Sorscher S. Inadequate Uptake of USPSTF-Recommended Low Dose CT Lung Cancer Screening. J Prim Care Community Health 2024; 15:21501319241235011. [PMID: 38400557 PMCID: PMC10894545 DOI: 10.1177/21501319241235011] [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: 01/16/2024] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
In 2023, Journal of Primary Care and Community Health published the results of 4 outstanding studies in which investigators aimed to explore and improve clinician and eligible individuals' knowledge of the rationale for lung cancer screening (LCS). Their results highlighted the underutilization of LCS, particularly for certain high risk populations, and the continued disparities in screening seen between groups of eligible individuals. Here, key findings from those 2023 Journal of Primary Care and Community Health reports, along with salient findings of other recent LCS reports, are discussed. The bases for the United States Preventive Task Force (USPSTF) LCS recommendations, barriers primary care providers face, the perspective of eligible individuals, importance of shared decision-making (SDM) and disparities between groups in LCS are reviewed along with potential strategies to ensure that more eligible individuals are offered LCS.
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Whitham T, Wima K, Harnett B, Kues JR, Eckman MH, Starnes SL, Schmidt KA, Kapur S, Salfity H, Van Haren RM. Lung cancer screening utilization rate varies based on patient, provider, and hospital factors. J Thorac Cardiovasc Surg 2023; 166:1331-1339. [PMID: 36934071 DOI: 10.1016/j.jtcvs.2023.01.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/26/2022] [Accepted: 01/20/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVE Low-dose computed tomography has been proven to reduce mortality, yet utilization remains low. The purpose of this study is to identify factors that impact the utilization of lung cancer screening. METHODS We performed a retrospective review of our institution's primary care network from November 2012 to June 2022 to identify patients who were eligible for lung cancer screening. Eligible patients were 55 to 80 years of age and current or former smokers with at least a 30 pack-year history. Analyses were performed on the screened populations and patients who met eligibility criteria but were not screened. RESULTS A total of 35,279 patients in our primary care network were current/former smokers aged 55 to 80 years. A total of 6731 patients (19%) had a 30 pack-year or more cigarette history, and 11,602 patients (33%) had an unknown pack-year history. A total of 1218 patients received low-dose computed tomography. The utilization rate of low-dose computed tomography was 18%. The utilization rate was significantly lower (9%) if patients with unknown pack-year history were included (P < .001). The utilization rates between primary care clinic locations were significantly different (range, 18% vs 41%, P < .05). Utilization of low-dose computed tomography on multivariate analysis was associated with Black race, former smoker, chronic obstructive pulmonary disease, bronchitis, family history of lung cancer, and number of primary care visits (all P < .05). CONCLUSIONS Lung cancer screening utilization rates are low and vary significantly on the basis of patient comorbidities, family history of lung cancer, primary care clinic location, and accurate documentation of pack-year cigarette history. The development of programs to address patient, provider, and hospital-level factors is needed to ensure appropriate lung cancer screening.
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Affiliation(s)
- Tarik Whitham
- College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio
| | - Koffi Wima
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Brett Harnett
- Department of Biomedical Informatics, University of Cincinnati, Cincinnati, Ohio
| | - John R Kues
- Center for Improvement Science, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Mark H Eckman
- Division of General Internal Medicine, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Sandra L Starnes
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Katherine A Schmidt
- Division of General Internal Medicine, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Sangita Kapur
- Division of Cardiopulmonary Imaging, Department of Radiology, University of Cincinnati, Ohio
| | - Hai Salfity
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Robert M Van Haren
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
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Chen LS, Baker TB, Ramsey A, Amos CI, Bierut LJ. Genomic medicine to reduce tobacco and related disorders: Translation to precision prevention and treatment. ADDICTION NEUROSCIENCE 2023; 7:100083. [PMID: 37602286 PMCID: PMC10434839 DOI: 10.1016/j.addicn.2023.100083] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Genomic medicine can enhance prevention and treatment. First, we propose that advances in genomics have the potential to enhance assessment of disease risk, improve prognostic predictions, and guide treatment development and application. Clinical implementation of polygenic risk scores (PRSs) has emerged as an area of active research. The pathway from genomic discovery to implementation is an iterative process. Second, we provide examples on how genomic medicine has the potential to solve problems in prevention and treatment using two examples: Lung cancer screening and evidence-based tobacco treatment are both under-utilized and great opportunities for genomic interventions. Third, we discuss the translational process for developing genomic interventions from evidence to implementation by presenting a model to evaluate genomic evidence for clinical implementation, mechanisms of genomic interventions, and patient desire for genomic interventions. Fourth, we present potential challenges in genomic interventions including a great need for evidence in all diverse populations, little evidence on treatment algorithms, challenges in accommodating a dynamic evidence base, and implementation challenges in real world clinical settings. Finally, we conclude that research to identify genomic markers that are associated with smoking cessation success and the efficacy of smoking cessation treatments is needed to empower people of all diverse ancestry. Importantly, genomic data can be used to help identify patients with elevated risk for nicotine addiction, difficulty quitting smoking, favorable response to specific pharmacotherapy, and tobacco-related health problems.
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Affiliation(s)
- Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, United States
| | - Timothy B. Baker
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - Alex Ramsey
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, United States
| | - Christopher I. Amos
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Department of Medicine, Baylor College of Medicine, Institute for Clinical and Translational Research, Houston, TX, United States
| | - Laura J. Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, United States
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Rivera MP, Gudina AT, Cartujano-Barrera F, Cupertino P. Disparities Across the Continuum of Lung Cancer Care. Clin Chest Med 2023; 44:531-542. [PMID: 37517833 DOI: 10.1016/j.ccm.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Despite the overall decline in lung cancer incidence and mortality, minority populations continue to bear a higher disease burden. Lung cancer remains the leading cause of cancer-related death in the United States and disproportionately impacts minority populations. Social determinants of health-including low-socioeconomic status, lack of health insurance, and access to health care- disproportionately impact racial, ethnic, and rural populations resulting in direct consequences on lung cancer disparities.
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Affiliation(s)
- M Patricia Rivera
- University of Rochester Medical Center, 601 Elmwood Avenue, Box 692, Rochester, NY 14642, USA.
| | - Abdi T Gudina
- University of Rochester Medical Center, 265 Crittenden Boulevard, Rm 2-223, Rochester, NY 14642, USA
| | | | - Paula Cupertino
- University of Rochester Medical Center, 601 Elmwood Avenue, Box SURG, Rochester, NY 14642, USA
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Jiang LG, Cahill M, Chansakul A, Steel PAD, Sullivan D, Pua BB. A Collaborative Emergency Medicine and Radiology Pulmonary Nodule Program: Identification of Associated Efficacy and Outcomes. J Am Coll Radiol 2023; 20:796-803. [PMID: 37422161 DOI: 10.1016/j.jacr.2023.04.020] [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: 02/08/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Incidental radiologic findings are commonplace, but the episodic nature of emergency department (ED) care makes it challenging to ensure that patients obtain appropriate follow-up. Rates of follow-up range from 30% to 77%, with some studies demonstrating that more than 30% have no follow-up at all. The aim of this study is to describe and analyze the outcomes of a collaborative emergency medicine and radiology initiative to establish a formal workflow for the follow-up of pulmonary nodules identified during ED care. METHODS A retrospective analysis was performed of patients referred to the pulmonary nodule program (PNP). Patients were divided into two categories: those with follow-up and those who do not have post-ED follow-up. The primary outcome was determining follow-up rates and outcomes, including patients referred for biopsy. The characteristics of patients who completed follow-up compared with those lost to follow-up were also examined. RESULTS A total of 574 patients were referred to the PNP. Initial follow-up was established in 390 (69.1%); 30.8% were considered lost to follow-up, and more than half of these patients did not respond to initial contact. There were minimal differences in characteristics between patients in these two categories. Of the 259 patients who completed PNP follow-up, 26 were referred for biopsy (13%). CONCLUSIONS The PNP provided effective transitions of care and potentially improved patient health care. Strategies to further enhance follow-up adherence will provide iterative improvement of the program. The PNP provides an implementation framework for post-ED pulmonary nodule follow-up in other health care systems and can be modified for use with other incidental diagnostic findings.
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Affiliation(s)
- Lynn G Jiang
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York.
| | - Meghan Cahill
- Department of Radiology, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York
| | - Aisara Chansakul
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York
| | - Peter A D Steel
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York
| | - Deirdre Sullivan
- Department of Radiology, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York
| | - Bradley B Pua
- Department of Radiology, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York
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Lowenstein LM, Shih YCT, Minnix J, Lopez-Olivo MA, Maki KG, Kypriotakis G, Leal VB, Shete SS, Fox J, Nishi SP, Cinciripini PM, Volk RJ. A protocol for a cluster randomized trial of care delivery models to improve the quality of smoking cessation and shared decision making for lung cancer screening. Contemp Clin Trials 2023; 128:107141. [PMID: 36878389 PMCID: PMC10164095 DOI: 10.1016/j.cct.2023.107141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 02/16/2023] [Accepted: 03/01/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Patients eligible for lung cancer screening (LCS) are those at high risk of lung cancer due to their smoking histories and age. While screening for LCS is effective in lowering lung cancer mortality, primary care providers are challenged to meet beneficiary eligibility for LCS from the Centers for Medicare & Medicaid Services, including a patient counseling and shared decision-making (SDM) visit with the use of patient decision aid(s) prior to screening. METHODS We will use an effectiveness-implementation type I hybrid design to: 1) identify effective, scalable smoking cessation counseling and SDM interventions that are consistent with recommendations, can be delivered on the same platform, and are implemented in real-world clinical settings; 2) examine barriers and facilitators of implementing the two approaches to delivering smoking cessation and SDM for LCS; and 3) determine the economic implications of implementation by assessing the healthcare resources required to increase smoking cessation for the two approaches by delivering smoking cessation within the context of LCS. Providers from different healthcare organizations will be randomized to usual care (providers delivering smoking cessation and SDM on site) vs. centralized care (smoking cessation and SDM delivered remotely by trained counselors). The primary trial outcomes will include smoking abstinence at 12-weeks and knowledge about LCS measured at 1-week after baseline. CONCLUSION This study will provide important new evidence about the effectiveness and feasibility of a novel care delivery model for addressing the leading cause of lung cancer deaths and supporting high-quality decisions about LCS. CLINICALTRIALS GOV PROTOCOL REGISTRATION NCT04200534 TRIAL REGISTRATION: ClinicalTrials.govNCT04200534.
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Affiliation(s)
- Lisa M Lowenstein
- Departments of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Ya-Chen Tina Shih
- Departments of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Jennifer Minnix
- Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Maria A Lopez-Olivo
- Departments of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Kristin G Maki
- Departments of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - George Kypriotakis
- Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Viola B Leal
- Departments of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sanjay S Shete
- Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - James Fox
- Pulmonary & Critical Care Medicine, The University of Texas Health East Texas, Tyler, TX, USA.
| | - Shawn P Nishi
- Pulmonary & Critical Care Medicine, The University of Texas Medical Branch, Galveston, TX, USA.
| | - Paul M Cinciripini
- Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Robert J Volk
- Departments of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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8
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Eberth JM, Zgodic A, Pelland SC, Wang SY, Miller DP. Outcomes of Shared Decision-Making for Low-Dose Screening for Lung Cancer in an Academic Medical Center. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:522-537. [PMID: 35488967 DOI: 10.1007/s13187-022-02148-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 05/20/2023]
Abstract
Shared decision-making (SDM) helps patients weigh risks and benefits of screening approaches. Little is known about SDM visits between patients and healthcare providers in the context of lung cancer screening. This study explored the extent that patients were informed by their provider of the benefits and harms of lung cancer screening and expressed certainty about their screening choice. We conducted a survey with 75 patients from an academic medical center in the Southeastern U.S. Survey items included knowledge of benefits and harms of screening, patients' value elicitation during SDM visits, and decisional certainty. Patient and provider characteristics were collected through electronic medical records or self-report. Descriptive statistics, Kruskal-Wallis tests, and Pearson correlations between screening knowledge, value elicitation, and decisional conflict were calculated. The sample was predominately non-Hispanic White (73.3%) with no more than high school education (53.4%) and referred by their primary care provider for screening (78.7%). Patients reported that providers almost always discussed benefits of screening (81.3%), but infrequently discussed potential harms (44.0%). On average, patients had low knowledge about screening (score = 3.71 out of 8) and benefits/harms. Decisional conflict was low (score = - 3.12) and weakly related to knowledge (R= - 0.25) or value elicitation (R= - 0.27). Black patients experienced higher decisional conflict than White patients (score = - 2.21 vs - 3.44). Despite knowledge scores being generally low, study patients experienced low decisional conflict regarding their decision to undergo lung cancer screening. Additional work is needed to optimize the quality and consistency of information presented to patients considering screening.
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Affiliation(s)
- Jan M Eberth
- Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene St., Columbia, SC, 29208, USA.
- Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, USA.
| | - Anja Zgodic
- Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene St., Columbia, SC, 29208, USA
- Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, USA
| | | | | | - David P Miller
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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9
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Gomes R, Nederveld A, Glasgow RE, Studts JL, Holtrop JS. Lung cancer screening in rural primary care practices in Colorado: time for a more team-based approach? BMC PRIMARY CARE 2023; 24:62. [PMID: 36869308 PMCID: PMC9982804 DOI: 10.1186/s12875-023-02003-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/06/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Despite lung cancer being a leading cause of death in the United States and lung cancer screening (LCS) being a recommended service, many patients eligible for screening do not receive it. Research is needed to understand the challenges with implementing LCS in different settings. This study investigated multiple practice members and patient perspectives impacting rural primary care practices related to LCS uptake by eligible patients. METHODS This qualitative study involved primary care practice members in multiple roles (clinicians n = 9, clinical staff n = 12 and administrators n = 5) and their patients (n = 19) from 9 practices including federally qualified and rural health centers (n = 3), health system owned (n = 4) and private practices (n = 2). Interviews were conducted regarding the importance of and ability to complete the steps that may result in a patient receiving LCS. Data were analyzed using a thematic analysis with immersion crystallization then organized using the RE-AIM implementation science framework to illuminate and organize implementation issues. RESULTS Although all groups endorsed the importance of LCS, all also struggled with implementation challenges. Since assessing smoking history is part of the process to identify eligibility for LCS, we asked about these processes. We found that smoking assessment and assistance (including referral to services) were routine in the practices, but other steps in the LCS portion of determining eligibility and offering LCS were not. Lack of knowledge about screening and coverage, patient stigma, and resistance and practical considerations such as distance to LCS testing facilities complicated completion of LCS compared to screening for other types of cancer. CONCLUSIONS Limited uptake of LCS results from a range of multiple interacting factors that cumulatively affect consistency and quality of implementation at the practice level. Future research should consider team-based approaches to conduct of LCS eligibility and shared decision making.
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Affiliation(s)
- Rebekah Gomes
- University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora, CO, USA
| | - Andrea Nederveld
- Department of Family Medicine, University of Colorado School of Medicine, Mail Stop F496, 12631 E. 17Th Ave, Aurora, CO, 80045, USA
| | - Russell E Glasgow
- University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora, CO, USA.,Department of Family Medicine, University of Colorado School of Medicine, Mail Stop F496, 12631 E. 17Th Ave, Aurora, CO, 80045, USA
| | - Jamie L Studts
- Department of Medicine, Division of Medical Oncology, and University of Colorado Cancer Center, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jodi Summers Holtrop
- University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora, CO, USA. .,Department of Family Medicine, University of Colorado School of Medicine, Mail Stop F496, 12631 E. 17Th Ave, Aurora, CO, 80045, USA.
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10
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Strayer TE, Spalluto LB, Burns A, Lindsell CJ, Henschke CI, Yankelevitz DF, Moghanaki D, Dittus RS, Vogus TJ, Audet C, Kripalani S, Roumie CL, Lewis JA. Using the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to study adaptations in lung cancer screening delivery in the Veterans Health Administration: a cohort study. Implement Sci Commun 2023; 4:5. [PMID: 36635719 PMCID: PMC9836333 DOI: 10.1186/s43058-022-00388-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/20/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Lung cancer screening is a complex clinical process that includes identification of eligible individuals, shared decision-making, tobacco cessation, and management of screening results. Adaptations to the delivery process for lung cancer screening in situ are understudied and underreported, with the potential loss of important considerations for improved implementation. The Framework for Reporting Adaptations and Modifications-Expanded (FRAME) allows for a systematic enumeration of adaptations to implementation of evidence-based practices. We applied FRAME to study adaptations in lung cancer screening delivery processes implemented by lung cancer screening programs in a Veterans Health Administration (VHA) Enterprise-Wide Initiative. METHODS We prospectively conducted semi-structured interviews at baseline and 1-year intervals with lung cancer screening program navigators at 10 Veterans Affairs Medical Centers (VAMCs) between 2019 and 2021. Using this data, we developed baseline (1st) process maps for each program. In subsequent years (year 1 and year 2), each program navigator reviewed the process maps. Adaptations in screening processes were identified, documented, and mapped to FRAME categories. RESULTS We conducted a total of 16 interviews across 10 VHA lung cancer screening programs (n=6 in year 1, n=10 in year 2) to collect adaptations. In year 1 (2020), six programs were operational and eligible. Of these, three reported adaptations to their screening process that were planned or in response to COVID-19. In year 2 (2021), all 10 programs were operational and eligible. Programs reported 14 adaptations in year 2. These adaptations were planned and unplanned and often triggered by increased workload; 57% of year 2 adaptations were related to the identification and eligibility of Veterans and 43% were related to follow-up with Veterans for screening results. Throughout the 2 years, adaptations related to data management and patient tracking occurred in 60% of programs to improve the data collection and tracking of Veterans in the screening process. CONCLUSIONS Using FRAME, we found that adaptations occurred primarily in the areas of patient identification and communication of results due to increased workload. These findings highlight navigator time and resource considerations for sustainability and scalability of existing and future lung cancer screening programs as well as potential areas for future intervention.
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Affiliation(s)
- Thomas E Strayer
- Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lucy B Spalluto
- Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Abby Burns
- Veterans Health Administration-Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA
| | - Christopher J Lindsell
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Veterans Health Administration - Phoenix VA Health Care System, Phoenix, AZ, USA
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Drew Moghanaki
- Veterans Health Administration - Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, CA, USA
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Robert S Dittus
- Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Timothy J Vogus
- Owen Graduate School of Management, Vanderbilt University, Nashville, TN, USA
| | - Carolyn Audet
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sunil Kripalani
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christianne L Roumie
- Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer A Lewis
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA.
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA.
- Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC) and Medicine Service, Nashville, TN, USA.
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Suite 1200, Nashville, TN, 37203, USA.
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11
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Li R, Chai Q, Chen F, Liu Q, Zhang H. Influencing factors of LDCT recommendation by physicians in Sichuan Province, China. Front Oncol 2023; 12:1049096. [PMID: 36686844 PMCID: PMC9846777 DOI: 10.3389/fonc.2022.1049096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/14/2022] [Indexed: 01/06/2023] Open
Abstract
The study aimed to investigate the influencing factors of physicians in recommending low-dose computed tomography (LDCT) for lung cancer screening to high-risk groups. A total of 1767 participants with good knowledge of LDCT were included in a cross-sectional study. Data about physicians' demographics, perception of barriers on LDCT screening, medical conditions for practicing medicine and the behavior of recommending LDCT were collected by a questionnaire. Physicians who care about the transportation convenience of patients were less likely to recommend LDCT (OR 0.568, 95% CI (0.423 to 0.763), p < 0.05). The physicians who considered LDCT expensive, recommended LDCT less than others (OR 0.308, 95% CI (0.186 to 0.510), p < 0.05). The false positive rate of LDCT can decrease the possibility of physicians' recommending (OR 0.542, 95% CI (0.387 to 0.758), p < 0.05). The physicians in oncology department and health management center were more likely to recommend LDCT (OR 2.282, 95% CI (1.557 to 3.345); OR 2.476, 95% CI (1.618 to 3.791)). The convenience of transportation, the price, and the\ false positive rate may be the main concerns among physicians on recommending LDCT to high-risk groups. The influencing factors of physicians' recommending on LDCT was various. Information technology, government support in price and self-improvement of LDCT should be gathered together to break the barriers on physicians' recommending on LDCT.
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Affiliation(s)
- Ruicen Li
- Department of Health Management Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China,Department of Industrial Engineering and Engineering Management, College of Business, Sichuan University, Chengdu, Sichuan, China
| | - Qi Chai
- Integrated Care Management Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Feng Chen
- Integrated Care Management Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China,*Correspondence: Feng Chen,
| | - Qing Liu
- Integrated Care Management Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hong Zhang
- Integrated Care Management Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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12
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Carter-Bawa L, Walsh LE, Schofield E, Williamson TJ, Hamann HA, Ostroff JS. Lung Cancer Screening Knowledge, Attitudes, and Practice Patterns Among Primary and Pulmonary Care Clinicians. Nurs Res 2023; 72:3-11. [PMID: 36260526 PMCID: PMC9772114 DOI: 10.1097/nnr.0000000000000629] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Lung cancer screening has the potential to identify lung cancer at an early stage when more treatment options exist. However, discussions with and referrals of screening-eligible patients remain unacceptably low. We need to better understand clinician knowledge, attitudes, and practice patterns to identify strategies to improve lung cancer screening uptake. Prior studies have focused on understanding these factors from physicians only. Nevertheless, many patients receive primary care from nurse practitioners and physician assistants where prevention and early detection conversations are most likely to occur. Therefore, we must engage the full range of clinicians treating screening-eligible patients. OBJECTIVES The aim of this study was to describe attitudes, beliefs and referral practice patterns, lung cancer screening knowledge, and concordance with lung cancer screening guidelines among nurse practitioners, physicians, and physician assistants in the United States. METHODS A descriptive, cross-sectional study was performed using survey methodology with clinical vignettes to examine clinician factors and concordance with U.S. Preventive Services Task Force lung cancer screening guidelines. RESULTS Participants scored low on attitudes toward shared decision-making, high on the importance of shared decision-making in lung cancer screening, and low on barriers to lung cancer screening referral. In addition, midrange scores on empathy toward patients with smoking history were noted. Lung cancer screening knowledge was low regardless of clinician specialty; the most endorsed response when presented with a hypothetical patient was to refer for lung cancer screening using a chest X-ray. DISCUSSION Findings demonstrate that most clinicians are nonconcordant with U.S. Preventive Services Task Force guidelines, erroneously believing a chest X-ray is appropriate for lung cancer screening. Clinicians must follow evidence-based practice guidelines, highlighting the need for targeted continuing education about lung cancer screening for clinicians who treat screening-eligible patients.
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13
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Choi Y, Peairs KS, Sateia HF, Riddell R, Zhang C, McGuire MJ. High Value Care in Cancer Surveillance and Screening: Evaluating an e-Curriculum for Primary Care Providers. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1472-1478. [PMID: 33723797 DOI: 10.1007/s13187-021-01986-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND With an expected shortage of oncologists, primary care providers (PCPs) may need to manage more cancer surveillance and screening, areas where educational resources for PCPs have been limited. The goal of this e-curriculum was for PCPs to learn surveillance and screening for several common cancers. METHODS The e-curriculum covered breast and colorectal cancer surveillance and lung cancer screening with (1) a pre-test assessing knowledge, attitudes, practice patterns, and confidence; (2) case vignette-based teaching; and (3) an immediate post-test (with knowledge and confidence items identical to the pre-test) providing feedback. A delayed post-test was administered several months later. The curriculum and test items were developed by content experts and evaluated in a primary care group practice. RESULTS Of 167 community PCPs, 152 completed the pre-test (91%), 145 completed the immediate post-test (87%), and 63 completed the delayed post-test (37%); 62 PCPs completed all three tests (37%). The median score on the pre-test was 43%, immediate post-test was 93%, and delayed post-test was 70%. For PCPs completing all three tests, the median scores were 50%, 90%, and 70%, respectively (p < 0.0001). The percentage of PCPs confident in their knowledge 4 to 6 months after module completion compared to the pre-test baseline was statistically significant for lung cancer screening but not for cancer surveillance. CONCLUSION This curriculum provided concise, effective education for PCPs on 3 common cancers. Limitations include content breadth and lack of data reflecting physician ordering patterns. Curricular strengths include its accessibility, immediate feedback, and effectiveness, with a significant improvement in immediate and delayed post-test knowledge. Given a lack of increased confidence to provide cancer surveillance, PCPs should rely on electronic medical record tools and other resources to guide appropriate surveillance care.
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Affiliation(s)
- Youngjee Choi
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | | | | | - Rebecca Riddell
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Maura J McGuire
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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14
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Li R, Luo L, Tao W, Huang W, Bao T. Level of knowledge on low-dose CT lung cancer screening in Sichuan province, China: a cross-sectional study. BMJ Open 2022; 12:e061987. [PMID: 36127104 PMCID: PMC9490565 DOI: 10.1136/bmjopen-2022-061987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Low-dose CT (LDCT) can help determine the early stage of lung cancer and reduce mortality. However, knowledge of lung cancer and lung cancer screening among community residents and medical workers, and potential factors that may affect medical institutions to set up LDCT are limited. DESIGN A cross-sectional study was conducted in Sichuan province, China, in 2021. Community residents, medical workers and medical institutions were randomly selected, and participants responded to related questionnaires. Knowledge of lung cancer and LDCT lung cancer screening was evaluated. Data analyses were performed using SAS V.9.4. RESULTS A total of 35 692 residents, 6350 medical workers and 81 medical institutions were recruited; 4.05% of the residents were very familiar with lung cancer and 37.89% were (completely) unfamiliar. Characteristics, such as age and level of education, were significantly related to residents who were very familiar with lung cancer. Furthermore, 22.87% of the residents knew that LDCT can effectively screen for early-stage lung cancer, which was correlated with smoking (OR 1.1300; 95% CI 1.0540 to 1.2110; p=0.006) and family history of cancer (OR 1.2210; 95% CI 1.1400 to 1.3080; p<0.0001); 66.06% of medical workers believed that LDCT can detect early-stage lung cancer. Technicians and nurses were less knowledgeable than doctors about whether LDCT can effectively screen for early-stage lung cancer (OR 0.6976; 95% CI 0.5399 to 0.9015; p=0.0059 and OR 0.6970; 95% CI 0.5718 to 0.8496; p=0.0004, respectively). Setting up LDCT in medical institutions was related to grade, administrative rank, number of hospital beds that opened and total number of medical workers. CONCLUSIONS The knowledge of lung cancer in residents is relatively low, and the knowledge of LDCT in screening (early-stage) lung cancer needs to be improved both in residents and medical workers. Possible factors that affect medical institutions to set up LDCT may need to be incorporated.
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Affiliation(s)
- Ruicen Li
- Department of Industrial Engineering and Engineering Management, Sichuan University, Chengdu, Sichuan, China
- Health Management Center, West China Hospital, Sichuan University, Chengdu, China
| | - Li Luo
- Department of Industrial Engineering and Engineering Management, Sichuan University, Chengdu, Sichuan, China
| | - Wenjuan Tao
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
| | - Wenxia Huang
- Department of Healthcare, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Bao
- Health Management Center, West China Hospital, Sichuan University, Chengdu, China
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15
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Raskin J, Snoeckx A, Janssens A, De Bondt C, Wener R, van de Wiel M, van Meerbeeck JP, Smits E. New Implications of Patients’ Sex in Today’s Lung Cancer Management. Cancers (Basel) 2022; 14:cancers14143399. [PMID: 35884463 PMCID: PMC9316757 DOI: 10.3390/cancers14143399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/04/2022] [Accepted: 07/11/2022] [Indexed: 12/01/2022] Open
Abstract
Simple Summary We aim to raise awareness that sex is an important factor to take into account in modern-day thoracic oncology practice. Summarized, women should be specifically targeted in smoking cessation campaigns and sex-specific barriers should be addressed. Women present more often with adenocarcinoma histology and EGFR/ALK alterations, as lung cancer in never-smokers is more common in women compared to men. Lung cancer in female patients may show a poorer response to immune checkpoint inhibition; therefore, the addition of chemotherapy should be considered. On the other hand, women experience more benefits from targeted therapy against EGFR. In general, prognosis for women is better compared to that in men. Lung cancer screening trials report that women derive more benefit from screening, although they have not been designed for women. Future trial designs should take this into account and encourage participation of women. Abstract This paper describes where and how sex matters in today’s management of lung cancer. We consecutively describe the differences between males and females in lung cancer demographics; sex-based differences in the immune system (including the poorer outcomes in women who are treated with immunotherapy but no chemotherapy); the presence of oncogenic drivers and the response to targeted therapies according to sex; the greater benefit women derive from lung cancer screening and why they get screened less; and finally, the barriers to smoking cessation that women experience. We conclude that sex is an important but often overlooked factor in modern-day thoracic oncology practice.
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Affiliation(s)
- Jo Raskin
- Department of Thoracic Oncology, MOCA, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium; (J.R.); (C.D.B.); (R.W.); (M.v.d.W.); (J.P.v.M.)
| | - Annemiek Snoeckx
- Department of Radiology, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium;
| | - Annelies Janssens
- Department of Thoracic Oncology, MOCA, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium; (J.R.); (C.D.B.); (R.W.); (M.v.d.W.); (J.P.v.M.)
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Universiteitsplein 1, 2610 Antwerpen, Belgium;
- Correspondence:
| | - Charlotte De Bondt
- Department of Thoracic Oncology, MOCA, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium; (J.R.); (C.D.B.); (R.W.); (M.v.d.W.); (J.P.v.M.)
| | - Reinier Wener
- Department of Thoracic Oncology, MOCA, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium; (J.R.); (C.D.B.); (R.W.); (M.v.d.W.); (J.P.v.M.)
| | - Mick van de Wiel
- Department of Thoracic Oncology, MOCA, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium; (J.R.); (C.D.B.); (R.W.); (M.v.d.W.); (J.P.v.M.)
| | - Jan P. van Meerbeeck
- Department of Thoracic Oncology, MOCA, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium; (J.R.); (C.D.B.); (R.W.); (M.v.d.W.); (J.P.v.M.)
| | - Evelien Smits
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Universiteitsplein 1, 2610 Antwerpen, Belgium;
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16
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Roubidoux MA, Kaur JS, Rhoades DA. Health Disparities in Cancer Among American Indians and Alaska Natives. Acad Radiol 2022; 29:1013-1021. [PMID: 34802904 DOI: 10.1016/j.acra.2021.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 12/15/2022]
Abstract
American Indians and Alaska Natives (AI/AN) are underserved populations who suffer from several health disparities, 1 of which is cancer. Malignancies, especially cancers of the breast, liver, and lung, are common causes of death in this population. Health care disparities in this population include more limited access to diagnostic radiology because of geographic and/or health system limitations. Early detection of these cancers may be enabled by improving patient and physician access to medical imaging. Awareness by the radiology community of the cancer disparities among this population is needed to support research targeted to this specific ethnic group and to support outreach efforts to provide more imaging opportunities. Providing greater access to imaging facilities will also improve patient compliance with screening recommendations, ultimately improving mortality in these populations.
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Affiliation(s)
- Marilyn A Roubidoux
- Department of Radiology, Michigan Medicine, TC 2910, 1500 E. Medical Center Drive, Ann Arbor, Mi 48109-5326.
| | - Judith S Kaur
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida
| | - Dorothy A Rhoades
- Department of Internal Medicine, Stephenson Cancer Center and the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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17
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Lei F, Chen WT, Brecht ML, Zhang ZF, Lee E. Health beliefs toward lung cancer screening among Chinese American high-risk smokers: Interviews based on Health Belief Model. Int J Nurs Sci 2022; 9:378-388. [PMID: 35891915 PMCID: PMC9305017 DOI: 10.1016/j.ijnss.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/13/2022] [Accepted: 06/09/2022] [Indexed: 11/25/2022] Open
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18
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Bhurosy T, Bover Manderski MT, Heckman CJ, Gonsalves NJ, Delnevo CD, Steinberg MB. Perceived effectiveness of cancer screening among family medicine and internal medicine physicians in the United States. Prev Med Rep 2022; 28:101842. [PMID: 35669859 PMCID: PMC9163580 DOI: 10.1016/j.pmedr.2022.101842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 05/03/2022] [Accepted: 05/20/2022] [Indexed: 11/30/2022] Open
Abstract
There are limited data on family medicine and internal medicine physicians’ beliefs regarding perceived cancer screening effectiveness. Perceiving specific cancer screening tests as very effective differed in some cases by gender, age, graduation year, and race/ethnicity. Physicians’ perceived effectiveness about cancer screening tests varies widely and may influence their recommendations or usage of these tests. Understanding physicians’ beliefs on screening effectiveness can help improve uptake of evidence-based screening by providers and patients to promote early detection and successful treatment.
Family and internal medicine physicians play an important role in cancer screening, yet there are limited data on their beliefs regarding effectiveness of screening tests, which may affect physicians’ likelihood to recommend such tests. The study purpose was to assess current beliefs among family medicine and internal medicine physicians regarding effectiveness of various types of cancer screening. A national sample of 582 physicians from the American Medical Association’s Physician Masterfile were surveyed. Participants were asked about their perceived effectiveness of screening for colon, lung, breast, prostate, and cervical cancer among average, healthy individuals. Chi-square tests were conducted to assess relationships between perceiving screening tests to be ‘very effective in reducing cancer-related mortality’ and demographic characteristics. A substantial majority of physicians perceived colonoscopy (83.8%) and Pap smear (82.9%) to be very effective. Perceiving low-dose computed tomography (LDCT), Pap smear, and prostate-specific antigen (PSA) as ‘very effective’ differed by gender, with females less likely to endorse LDCT and Pap smear but more likely to endorse PSA. Perceiving PSA as ‘very effective’ differed by age and graduation year, with younger or more recently graduated physicians being less likely to perceive PSA as ‘very effective’. Non-Hispanic Black/African-American physicians were more likely to perceive mammography as ‘very effective’ than other groups. Physicians’ perceived effectiveness about cancer screening tests varies widely and may influence their recommendations or usage of these tests. Understanding physicians’ beliefs can help in improving uptake of evidence-based screening tests by providers and patients to promote early detection and successful treatment.
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Affiliation(s)
- Trishnee Bhurosy
- Department of Population Health, School of Health Professions and Human Services, Hofstra University, Hempstead, NY 11549, USA
| | - Michelle T. Bover Manderski
- Center for Tobacco Studies, Rutgers University, New Brunswick, NJ 08901, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Carolyn J. Heckman
- Cancer Prevention and Control Program, Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ 08901, USA
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
- Corresponding author.
| | - Nishi J. Gonsalves
- Center for Tobacco Studies, Rutgers University, New Brunswick, NJ 08901, USA
| | - Cristine D. Delnevo
- Center for Tobacco Studies, Rutgers University, New Brunswick, NJ 08901, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Michael B. Steinberg
- Center for Tobacco Studies, Rutgers University, New Brunswick, NJ 08901, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
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19
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Kota KJ, Ji S, Bover-Manderski MT, Delnevo CD, Steinberg MB. Lung Cancer Screening Knowledge and Perceived Barriers Among US Physicians. JTO Clin Res Rep 2022; 3:100331. [PMID: 35769389 PMCID: PMC9234709 DOI: 10.1016/j.jtocrr.2022.100331] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Lung cancer remains the leading cause of cancer death in the United States and has historically been detected late in its course. Low-dose computed tomography scan (LDCT) reduces lung cancer mortality by 20% and is currently recommended by clinical practice guidelines. However, compared with other cancer screening modalities, LDCT utilization remains low. This study surveyed office-based primary care physicians across the United States to better understand LDCT utilization. Methods A total of 1500 family and internal medicine physicians selected from the American Medical Association’s physician master file were surveyed between April and July 2019 regarding LDCT practices, eligibility, clinical scenarios, and perceived barriers. Results The American Association for Public Opinion Research response rate 3 was 59% (652 respondents); 599 completed supplemental questions regarding lung cancer screening. A total of 88% of respondents discussed LDCT in the previous year, and 78% had ordered at least one LDCT. Most (59%) knew the tobacco exposure criteria for LDCT and correctly identified appropriate clinical scenarios (49%–86% responded correctly). Less than half of respondents correctly identified the age eligibility criteria (44%–45% responded correctly). In general, male physicians, those who graduated after 1990, and family medicine physicians were more likely to report accurate knowledge regarding LDCT eligibility. The top perceived barriers to LDCT were cost to the patient (48% identified as a major barrier), insurance not covering screening (46% major), and patients being unaware of lung cancer screening (40% major). Conclusion Knowledge and practices about lung cancer screening are improving, though remain suboptimal. The most common barriers remain cost or insurance-based and suggest the need for a systems-based response to increase awareness and reduce the underutilization of LDCT.
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Ortmeyer K, Ma GX, Kaiser LR, Erkmen C. Effective Educational Approaches to Training Physicians About Lung Cancer Screening. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:52-57. [PMID: 32504361 PMCID: PMC7718418 DOI: 10.1007/s13187-020-01784-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In 2013, the U.S. Preventative Services Task Force recommended low-dose computed tomography (LDCT) for lung cancer screening (LCS) after a national trial demonstrated a 20% reduction in lung cancer mortality with LDCT. Implementation of LCS employing LDCT depends heavily on physician education regarding multiple factors, including eligibility criteria, potential benefits and harms, and shared decision-making. To date, there are no studies of educational approaches for teaching physicians about LCS. This study aims to assess the feasibility and effectiveness of implementing an interactive, group-based learning (GBL) curriculum to teach physicians about LCS. A prospective study was conducted at two nearby institutions from 2017 to 2019 comparing GBL with a lecture format as measured by total knowledge about LCS, acceptability of the educational format, and ease of implementation. We surveyed participants regarding total knowledge and format acceptance. Results were compared to determine whether GBL is an effective and feasible educational strategy for LDCT and LCS education. Residents and faculty participating in GBL demonstrated greater total knowledge compared with residents and faculty participating in the lecture format. Participants in both cohorts preferred a mix of GBL and lecture formats. All participants believed that GBL facilitates implementation of LCS better than lecture-based learning. GBL is an effective and feasible approach for educating physicians about LCS, though it is more time- and resource-intensive than a lecture approach. However, healthcare providers believe GBL will facilitate implementation of LCS more than lectures.
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Affiliation(s)
- Katherine Ortmeyer
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Grace X Ma
- Center for Asian Health, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Larry R Kaiser
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Cherie Erkmen
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
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21
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Urrutia Argueta S, Basnet N, Abdul-Kafi O, Hanna N. Lung Cancer Screening Knowledge in Four Internal Medicine Programs. Cancer Control 2022; 29:10732748221081383. [PMID: 36895164 PMCID: PMC10009012 DOI: 10.1177/10732748221081383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
INTRODUCTION Lung cancer remains the leading cause of cancer-related death in the United States. Low density CT (LDCT) has been shown to reduce mortality in high-risk populations. Recognizing and mitigating gaps in knowledge in early medical training could result in increased utilization of screening CT in high risk-populations. METHODS An electronic survey was conducted among Internal Medicine (IM) residents at 4 academic programs in the Midwestern United States. A survey was distributed to evaluate knowledge about high-risk populations, mortality benefits, and a comparison in mortality benefits between LDCT and other screening modalities using number needed to screen (NNS). Results: There was a 46.6% (166/360) response rate. Residents correctly answered an average of 2.9/7 (43.1%) questions. PGY-1 (post-graduate year) and PGY-2 residents performed better than PGY-3 (P = .022). Only 1/3 rd of all respondents correctly identified the population needed to be screened. Over 80% of residents thought screening with LDCT had a cancer-specific mortality benefit but were evenly split (except Program 2 residents), on recognizing an all-cause mortality benefit with LDCT, (P = .016). Only 7.7% thought women benefited the most from LDCT. Self-assess and attained knowledge were similar among programs. CONCLUSIONS LDCT is a noninvasive intervention with a substantial mortality reduction, especially in states with high rates of smoking, and is widely covered by insurers. With average knowledge score less than 50%, this study shows there is a substantial need to increase the knowledge of LCS in IM residency programs.
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Affiliation(s)
| | - Nishraj Basnet
- Department of Medicine, 3078Michigan State University, Indianapolis, IN, USA
| | - Owais Abdul-Kafi
- Department of Medicine, 14681University of Illinois Chicago, Chicago, IL, USA
| | - Nasser Hanna
- Department of Medicine, 12250Indiana University, Indianapolis, IN, USA
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22
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Urrutia Argueta S, Hanna N. Lung Cancer Screening Knowledge Among Internal Medicine Residents in a University Program. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:1186-1192. [PMID: 32307666 DOI: 10.1007/s13187-020-01747-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Lung cancer remains the main cause of cancer-related death. Even though several societies recommend that certain populations may benefit from lung cancer screening with low-dose computed tomography (LDCT), its nationwide adoption has been slow. Practices in primary care are closely linked to residency training. Recognizing gaps in knowledge during training may translate into increased utilization of life-saving measures. Sixty internal medicine residents training at a university-based program were presented with an anonymous online-based survey designed to measure their knowledge about lung cancer screening. In the second phase, residents were presented with an infographic containing the answers to the initial survey. They were surveyed again 30 days after this intervention. The average correct response rate among all years was 42%. PGY-1 residents performed better compared with PGY-2 and PGY-3 residents (p = 0.015). Ninety-two percent of residents did not think screening improved all-cause mortality. Less than half thought screening had a lung cancer-specific mortality benefit. Fifty-three percent rated their self-perceived knowledge above 50%. There was no difference in knowledge after the intervention. Specific populations may benefit from LDCT screening. Even if these benefits do not directly translate to population settings, the burden and mortality of lung cancer calls for urgent measures to attempt an earlier diagnosis. Internal medicine residents in this program may have several concerns about lung cancer screening including coverage, benefit, and false positive rate. Educational methods such as infographics may not be effective in improving knowledge among residents. Lung cancer screening should be a priority in medical education, especially in states with high smoking rates and lung cancer mortality.
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Affiliation(s)
| | - Nasser Hanna
- Indiana University Simon Cancer Center, Indianapolis, IN, USA
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Dodd RH, Zhang C, Sharman AR, Carlton J, Tang R, Rankin NM. Assessing information available for health professionals and potential participants on lung cancer screening program websites: a cross-sectional study (Preprint). JMIR Cancer 2021; 8:e34264. [PMID: 36040773 PMCID: PMC9472061 DOI: 10.2196/34264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 05/21/2022] [Accepted: 06/07/2022] [Indexed: 11/28/2022] Open
Abstract
Background Lung cancer is the leading cause of cancer death worldwide. The US Preventive Services Task Force (USPSTF) updated recommendations for lung cancer screening in 2021, adjusting the age of screening to 50 years (from 55 years) and reducing the number of pack-years used to estimate total firsthand cigarette smoke exposure to 20 (from 30). With many individuals using the internet to find health care information, it is important to understand what information is available for individuals contemplating lung cancer screening. Objective This study aimed to assess the eligibility criteria and information available on lung cancer screening program websites for both health professionals and potential screening participants. Methods A descriptive cross-sectional analysis of 151 lung cancer screening program websites of academic (n=76) and community medical centers (n=75) in the United States with information for health professionals and potential screening participants was conducted in March 2021. Presentation of eligibility criteria for potential screening participants and presence of information available specific to health professionals about lung cancer screening were the primary outcomes. Secondary outcomes included presentation of information about cost and smoking cessation, inclusion of an online risk assessment tool, mention of any clinical guidelines, and use of multimedia to present information. Results Eligibility criteria for lung cancer screening was included in nearly all 151 websites (n=142, 94%), as well as age range (n=139, 92.1%) and smoking history (n=141, 93.4%). Age was only consistent with the latest recommendations in 14.5% (n=22) of websites, and no websites had updated smoking history. Half the websites (n=76, 50.3%) mentioned screening costs as related to the type of insurance held. A total of 23 (15.2%) websites featured an online assessment tool to determine eligibility. The same proportion (n=23, 15.2%) hosted information specifically for health professionals. In total, 44 (29.1%) websites referred to smoking cessation, and 46 (30.5%) websites used multimedia to present information, such as short videos or podcasts. Conclusions Most websites of US lung cancer screening programs provide information about eligibility criteria, but this is not consistent and has not been updated across all websites following the latest USPSTF recommendations. Online resources require updating to present standardized information that is accessible for all.
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Affiliation(s)
- Rachael H Dodd
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Chenyue Zhang
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ashleigh R Sharman
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Julie Carlton
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ruijin Tang
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Nicole M Rankin
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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24
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Li CC, Matthews AK, Kao YH, Lin WT, Bahhur J, Dowling L. Examination of the Association Between Access to Care and Lung Cancer Screening Among High-Risk Smokers. Front Public Health 2021; 9:684558. [PMID: 34513780 PMCID: PMC8424050 DOI: 10.3389/fpubh.2021.684558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/23/2021] [Indexed: 12/04/2022] Open
Abstract
Objective: The purpose of this study was to examine the influence of access to care on the uptake of low-dose computed tomography (LDCT) lung cancer screening among a diverse sample of screening-eligible patients. Methods: We utilized a cross-sectional study design. Our sample included patients evaluated for lung cancer screening at a large academic medical center (AMC) between 2015 and 2017 who met 2013 USPSTF guidelines for LDCT screening eligibility. The completion of LDCT screening (yes, no) was the primary dependent variable. The independent variable was access to care (insurance type, living within the AMC service area). We utilized binary logistic regression analyses to examine the influence of access to care on screening completion after adjusting for demographic factors (age, sex, race) and smoking history (current smoking status, smoking pack-year history). Results: A total of 1,355 individuals met LDCT eligibility criteria, and of those, 29.8% (n = 404) completed screening. Regression analysis results showed individuals with Medicaid insurance (OR, 1.51; 95% CI, 1.03-2.22), individuals living within the AMC service area (OR, 1.71; 95% CI, 1.21-2.40), and those aged 65-74 years (OR, 1.49; 95% CI, 1.12-1.98) had higher odds of receiving LDCT lung cancer screening. Lower odds of screening were associated with having Medicare insurance (OR, 0.30; 95% CI, 0.22-0.41) and out-of-pocket (OR, 0.27; 95% CI, 0.15-0.47). Conclusion: Access to care was independently associated with lowered screening rates. Study results are consistent with prior research identifying the importance of access factors on uptake of cancer early detection screening behaviors.
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Affiliation(s)
- Chien-Ching Li
- Department of Health Systems Management, Rush University, Chicago, IL, United States
| | - Alicia K. Matthews
- Department of Population Health Nursing Science, The University of Illinois at Chicago, Chicago, IL, United States
| | - Yu-Hsiang Kao
- Department of Behavioral and Community Health Sciences, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Wei-Ting Lin
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, LA, United States
| | - Jad Bahhur
- Department of RUMG Administration, Rush University Medical Center, Chicago, IL, United States
| | - Linda Dowling
- Department of RUMG Administration, Rush University Medical Center, Chicago, IL, United States
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25
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Miller JA, Tatakis A, Van Haren RM, Kapur S, Pathrose P, Hemingway M, Starnes SL. A Structured Program Maximizes Benefit of Lung Cancer Screening in an Area of Endemic Histoplasmosis. Ann Thorac Surg 2021; 114:241-247. [PMID: 34339671 DOI: 10.1016/j.athoracsur.2021.06.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 05/04/2021] [Accepted: 06/23/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Lung cancer screening with low-dose computed tomography has demonstrated at least a 20% decrease in lung cancer-specific mortality, but has the potential harm of unnecessary invasive procedures due to false positive results. We report the outcomes of a structured multi-disciplinary lung cancer screening program in an area of endemic histoplasmosis. METHODS A retrospective review of patients undergoing lung cancer screening from December 2012 to March 2019 was conducted. Findings suspicious for lung cancer were presented at a multidisciplinary thoracic tumor board. Patients were assigned to interval imaging follow-up, additional diagnostic imaging, or referral for an invasive procedure. Invasive procedures were then compared between benign and malignant pathologies. RESULTS 4087 scans were done on 2129 patients. 372 (9.1%) were suspicious and presented at a multidisciplinary thoracic tumor board. Ultimately 108 procedures were done: 55 bronchoscopies, seven percutaneous biopsies, and 46 operations. 25 patients (1.2%) underwent bronchoscopy resulting in benign pathology, significantly associated with an indication of an endobronchial lesion (p=0.01). All percutaneous biopsies revealed malignancy. Five patients (0.2%) who underwent resection had benign disease. Lung cancer was diagnosed in 67 patients (3.1% of the entire cohort), 46 of which were stage I/II. CONCLUSIONS Lung cancer screening in a structured, multidisciplinary program successfully identifies patients with early-stage lung cancer with limited unnecessary surgical interventions. Isolated endobronchial lesions should undergo short interval imaging follow up to avoid bronchoscopy for benign disease. Future studies to minimize unnecessary procedures could incorporate biomarkers and advanced imaging analysis into risk assessment models.
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Affiliation(s)
- James A Miller
- University of Cincinnati, Department of Surgery, Division of Thoracic Surgery, Cincinnati, OH, USA
| | - Anna Tatakis
- University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Robert M Van Haren
- University of Cincinnati, Department of Surgery, Division of Thoracic Surgery, Cincinnati, OH, USA
| | - Sangita Kapur
- University of Cincinnati, Department of Radiology, Cincinnati, OH, USA
| | - Peterson Pathrose
- University of Cincinnati, Department of Surgery, Division of Thoracic Surgery, Cincinnati, OH, USA
| | - Mona Hemingway
- University of Cincinnati, Department of Surgery, Division of Thoracic Surgery, Cincinnati, OH, USA
| | - Sandra L Starnes
- University of Cincinnati, Department of Surgery, Division of Thoracic Surgery, Cincinnati, OH, USA.
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26
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Maki KG, Liao K, Lowenstein LM, Lopez-Olivo MA, Volk RJ. Factors Associated With Obtaining Lung Cancer Screening Among Persons Who Smoke. MDM Policy Pract 2021; 6:23814683211067810. [PMID: 34993342 PMCID: PMC8725001 DOI: 10.1177/23814683211067810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/23/2021] [Indexed: 11/15/2022] Open
Abstract
Background. Screening with low-dose computed tomography scans can reduce lung cancer deaths but uptake remains low. This study examines psychosocial factors associated with obtaining lung cancer screening (LCS) among individuals. Methods. This is a secondary analysis of a randomized clinical trial conducted with 13 state quitlines’ clients. Participants who met age and smoking history criteria were enrolled and followed-up for 6 months. Only participants randomized to the intervention group (a patient decision aid) were included in this analysis. A logistic regression was performed to identify determinants of obtaining LCS 6 months after the intervention. Results. There were 204 participants included in this study. Regarding individual attitudes, high and moderate levels of concern about overdiagnosis were associated with a decreased likelihood of obtaining LCS compared with lower levels of concern (high levels of concern, odds ratio [OR] 0.17, 95% confidence interval [CI] 0.04–0.65; moderate levels of concern, OR 0.15, 95% CI 0.05–0.53). In contrast, higher levels of anticipated regret about not obtaining LCS and later being diagnosed with lung cancer were associated with an increased likelihood of being screened compared with lower levels of anticipated regret (OR 5.59, 95% CI 1.72–18.10). Other potential harms related to LCS were not significant. Limitations. Follow-up may not have been long enough for all individuals who wished to be screened to complete the scan. Additionally, participants may have been more health motivated due to recruitment via tobacco quitlines. Conclusions. Anticipated regret about not obtaining screening is associated with screening behavior, whereas concern about overdiagnosis is associated with decreased likelihood of LCS. Implications. Decision support research may benefit from further examining anticipated regret in screening decisions. Additional training and information may be helpful to address concerns regarding overdiagnosis.
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Affiliation(s)
| | | | | | | | - Robert J. Volk
- Robert J. Volk, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1444, Houston, TX 77030, USA; Telephone: (713) 745-4516 ()
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27
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Schiffelbein JE, Carluzzo KL, Hasson RM, Alford-Teaster JA, Imset I, Onega T. Barriers, Facilitators, and Suggested Interventions for Lung Cancer Screening Among a Rural Screening-Eligible Population. J Prim Care Community Health 2021; 11:2150132720930544. [PMID: 32506999 PMCID: PMC7278309 DOI: 10.1177/2150132720930544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction: Rural areas are disproportionally affected by lung cancer late-stage incidence and mortality. Lung cancer screening (LCS) is recommended to find lung cancer early and reduce mortality, yet uptake is low. The purpose of this study was to elucidate the barriers to, facilitators of, and suggested interventions for increasing LCS among a rural screening-eligible population using a mixed methods concurrent embedded design study. Methods: Qualitative and quantitative data were collected from rural-residing adults who met the eligibility criteria for LCS but who were not up-to-date with LCS recommendations. Study participants (n = 23) took part in 1 of 5 focus groups and completed a survey. Focus group discussions were recorded, transcribed, and coded through a mixed deductive and inductive approach. Survey data were used to enhance and clarify focus group results; these data were integrated in the design and during analysis, in accordance with the mixed methods concurrent embedded design approach. Results: Several key barriers to LCS were identified, including an overall lack of knowledge about LCS, not receiving information or recommendation from a health care provider, and lack of transportation. Key facilitators were receiving a provider recommendation and high motivation to know the screening results. Participants suggested that LCS uptake could be increased by addressing provider understanding and recommendation of LCS and conducting community outreach to promote LCS awareness and access. Conclusion: The results suggest that the rural screening-eligible population is generally receptive to LCS. Patient-level factors important to getting this population screened include knowledge, transportation, motivation to know their screening results, and receiving information or recommendation from a provider. Addressing these factors may be important to increase rural LCS uptake.
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Affiliation(s)
- Jenna E Schiffelbein
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | | | - Rian M Hasson
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.,Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jennifer A Alford-Teaster
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Inger Imset
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Tracy Onega
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
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28
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Allen CG, Cotter MM, Smith RA, Watson L. Successes and challenges of implementing a lung cancer screening program in federally qualified health centers: a qualitative analysis using the Consolidated Framework for Implementation Research. Transl Behav Med 2021; 11:1088-1098. [PMID: 33289828 PMCID: PMC8248958 DOI: 10.1093/tbm/ibaa121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
In recent years, studies have shown that low-dose computed tomography (LDCT) is a safe and effective way to screen high-risk adults for lung cancer. Despite this, uptake remains low, especially in limited-resource settings. The American Cancer Society (ACS) partnered with two federally qualified health centers and accredited screening facilities on a 2 year pilot project to implement an LDCT screening program. Both sites attempted to develop a referral program and care coordination practices to move patients through the screening continuum and identify critical facilitators and barriers to implementation. Evaluators conducted key informant interviews (N = 46) with clinical and administrative staff, as well as regional ACS staff during annual site visits. The Consolidated Framework for Implementation Research guided our analysis of factors associated with effective implementation and improved screening outcomes. One study site established a sustainable lung screening program, while the other struggled to overcome significant implementation barriers. Increased time spent with patients, disruption to normal workflows, and Medicaid reimbursement policies presented challenges at both sites. Supportive, engaged leaders and knowledgeable champions who provided clear implementation guidance improved staff engagement and were able to train, guide, and motivate staff throughout the intervention. A slow, stepwise implementation process allowed one site's project champions to pilot test new processes and resolve issues before scaling up. This pilot study provides critical insights into the necessary resources and steps for successful lung cancer screening program implementation in underserved settings. Future efforts can build upon these findings and identify and address possible facilitators and barriers to screening program implementation.
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Affiliation(s)
- Caitlin G Allen
- Department of Behavioral Science and Health Education,
Rollins School of Public Health, Emory University, Atlanta, GA,
USA
| | - Megan M Cotter
- Population Sciences Department, American Cancer Society,
Inc., Atlanta, GA, USA
| | - Robert A Smith
- Prevention and Early Detection Team, American Cancer
Society, Inc., Atlanta, GA, USA
| | - Lesley Watson
- Strategy and Analytics Team, American Cancer Society
Cancer Action Network, Inc., Washington, DC, USA
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29
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Monu JI, Achar C, Wood DE, Flum DR, Agrawal N, Farjah F. Psychological Traits and the Persuasiveness of Lung Cancer Screening Health Messages. Ann Thorac Surg 2021; 113:1341-1347. [PMID: 33957098 DOI: 10.1016/j.athoracsur.2021.04.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 04/07/2021] [Accepted: 04/15/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lung cancer screening remains underutilized despite its proven mortality benefit. Health systems have attempted to increase screening awareness through advertising. Psychological theories suggest that construal level (a personal orientation towards the big picture or the details) and regulatory focus (goals emphasizing acquisition of a good, or avoidance of a bad outcome) play a key role in health advertising effectiveness. These theories have not been examined in a screen-eligible population. METHODS Using Amazon's crowdsourcing platform, Mechanical Turk, we identified screen-eligible individuals based on United States Preventive Services Task Force criteria. We randomly assigned participants to see one of four screening advertisement images in a 2 (construal level: high vs. low) X 2 (regulatory focus: promotion vs. prevention) between-subjects experimental design. We assessed willingness to undergo screening following the advertisement. RESULTS A total of 191 individuals responded to our study invitation (mean age 61 years). We found that the high construal/promotion focus image led to a greater willingness to screen compared to images representing other psychological states (p-value=0.04). Regarding the personality traits of our respondents, high construal/promotion focus was the most prevalent (40%) trait combination, whereas low construal/prevention focus was the least prevalent (17%). CONCLUSIONS The psychological focus of health-related messages affect an individual's willingness to undergo lung cancer screening. Individuals eligible for lung cancer screening are more persuaded by "big picture" messages describing the benefits of screening. Health systems may use this knowledge to design more effective patient-facing communications that lead to higher rates of screening.
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Affiliation(s)
- John I Monu
- Department of Surgery, University of Washington, Seattle, WA
| | - Chethana Achar
- Kellogg School of Management, Northwestern University, Evanston, IL
| | - Douglas E Wood
- Department of Surgery, University of Washington, Seattle, WA
| | - David R Flum
- Department of Surgery, University of Washington, Seattle, WA
| | - Nidhi Agrawal
- Michael G. Foster School of Business, University of Washington, Seattle, WA
| | - Farhood Farjah
- Department of Surgery, University of Washington, Seattle, WA.
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30
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Kowalski L, Krusen NE. Lung Cancer Screening Policy in Alaska and Occupational Therapy. Am J Occup Ther 2021; 75:12496. [PMID: 34781340 DOI: 10.5014/ajot.2021.048231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Lung cancer claims more lives than any other cancer in the world and remains difficult to diagnose in the early stages. This article examines the current state of lung cancer detection and screening via low-dose computed tomography (LDCT) in Alaska and considers potential opportunities for occupational therapy practitioners in primary care settings. Medicare requires at least one documented shared decision-making encounter between provider and patient before LDCT lung cancer screening occurs. As a result of time constraints, documentation requirements, and the plethora of preventive health services they provide, primary care physicians often lack the time and training to conduct this essential service. This provides an opportunity for occupational therapy practitioners to perform these services as part of their practice and to play a role in this area as patient educators and prevention specialists in primary care settings. What This Article Adds: This article explores the national health crisis of lung cancer and describes how occupational therapists can participate in providing care in primary care settings.
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Affiliation(s)
- Lesleigh Kowalski
- Lesleigh Kowalski, PhD, MOT, OTR/L, ATP, is Research Scientist, Department of Family Medicine, University of Washington, Seattle; . At the time of the research, Kowalski was Doctoral Student, College of Health of Professions, Pacific University, Forest Grove, OR
| | - Nancy E Krusen
- Nancy E. Krusen, PhD, MA, OTR/L, is Program Director and Associate Professor, Division of Occupational Therapy Education, University of Nebraska Medical Center, Omaha
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31
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Miller EA, Pinsky PF. Healthcare Access, Utilization, and Preventive Health Behaviors by Eligibility for Lung Cancer Screening. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:330-337. [PMID: 31656025 DOI: 10.1007/s13187-019-01634-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
In 2013, the US Preventive Services Task Force recommended low-dose computed tomography screening for smokers at high risk of lung cancer; however, use remains low. Efforts to promote lung cancer screening need to consider how receptive this population is to preventive healthcare and cancer screening. In addition, because of demonstrated heterogeneity in behaviors by smoking status, interventions may need to differ among eligible high-risk subgroups. To assess the engagement of high-risk smokers in other preventive healthcare behaviors, we examined healthcare use, including non-lung cancer screening, and healthcare provider discussions regarding screening by eligibility for lung cancer screening. We used the 2015 National Health Interview Survey to assess smoking history, healthcare use, cancer screening, vaccinations, and healthcare provider discussions regarding non-lung cancer screening. We calculated weighted prevalence estimates and prevalence ratios comparing eligible and ineligible current and former smokers to never smokers. Eligible current and former smokers had significantly different healthcare utilization and screening concordance compared to never smokers and to each other. Compared to never smokers, eligible current smokers were significantly less likely to be concordant with breast, colorectal, and cervical cancer screening while eligible former smokers were only less likely to be concordant with breast cancer screening. Eligible current smokers were less likely to report physician discussions about non-lung screening tests. Provider discussions about screening and engagement in preventive healthcare differed among current and former smokers eligible for lung cancer screening. Intervention efforts to increase lung cancer screening levels will likely need to differ as well.
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Affiliation(s)
- Eric A Miller
- Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA.
| | - Paul F Pinsky
- Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA
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32
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Hasson RM, Fay KA, Phillips JD, Millington TM, Finley DJ. Rural barriers to early lung cancer detection: Exploring access to lung cancer screening programs in New Hampshire and Vermont. Am J Surg 2021; 221:725-730. [PMID: 32829909 PMCID: PMC10750228 DOI: 10.1016/j.amjsurg.2020.06.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/19/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Rural populations face many health disadvantages compared to urban areas. There is a critical need to better understand the current lung cancer screening landscape in these communities to identify targeted areas to improve the impact of this proven tool. METHODS Data from the County Health Rankings of New Hampshire and Vermont was reviewed for population density, distribution of adult smokers, and level of education compared to the distribution of Lung Cancer Screening Facilities throughout these two states. RESULTS Screening programs in southern counties of Vermont with lower levels of education have decreased access. In New Hampshire, there are no programs within 30 miles of the areas with the largest distribution of smokers, and decreased access in some areas with the lowest levels of education. CONCLUSIONS Improving equitable access to high-quality screening services in rural regions and the creation of targeted interventions to address decreased access in areas of high tobacco use and low education is vital to decreasing the incidence of latestage presentations of lung cancer within these populations.
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Affiliation(s)
- Rian M Hasson
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Section of Thoracic Surgery, 1 Medical Center Drive, NH 03756, Lebanon; The Dartmouth Institute for Health Policy and Clinical Practice, 1 Medical Center Drive, NH 03756, Lebanon.
| | - Kayla A Fay
- The Dartmouth Institute for Health Policy and Clinical Practice, 1 Medical Center Drive, NH 03756, Lebanon.
| | - Joseph D Phillips
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Section of Thoracic Surgery, 1 Medical Center Drive, NH 03756, Lebanon.
| | - Timothy M Millington
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Section of Thoracic Surgery, 1 Medical Center Drive, NH 03756, Lebanon.
| | - David J Finley
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Section of Thoracic Surgery, 1 Medical Center Drive, NH 03756, Lebanon.
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33
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Bou Akl I, K Zgheib N, Matar M, Mukherji D, Bardus M, Nasr R. Primary care and pulmonary physicians' knowledge and practice concerning screening for lung cancer in Lebanon, a middle-income country. Cancer Med 2021; 10:2877-2884. [PMID: 33742559 PMCID: PMC8026943 DOI: 10.1002/cam4.3816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 02/15/2021] [Indexed: 12/19/2022] Open
Abstract
Background Screening for lung cancer with low‐dose computed tomography (LDCT) was shown to reduce lung cancer incidence and overall mortality, and it has been recently included in international guidelines. Despite the rising burden of lung cancer in low and middle‐income countries (LMICs) such as Lebanon, little is known about what primary care physicians or pulmonologists know and think about LDCT as a screening procedure for lung cancer, and if they recommend it. Objectives Evaluate the knowledge about LDCT and implementation of international guidelines for lung cancer screening among Lebanese primary care physicians (PCPs) and pulmonary specialists. Methodology PCPs and PUs based in Lebanon were surveyed concerning knowledge and practices related to lung cancer screening by self‐administered paper questionnaires. Results 73.8% of PCPs and 60.7% of pulmonary specialists recognized LDCT as an effective tool for lung cancer screening, with 63.6% of PCPs and 71% of pulmonary specialists having used it for screening. However, only 23.4% of PCPs and 14.5% of pulmonary specialists recognized the eligibility criteria for screening. Chest X‐ray was recognized as ineffective by only 55.8% of PCPs and 40.7% of pulmonary specialists; indeed, 30.2% of PCPs and 46% of pulmonary specialists continue using it for screening. The majority have initiated a discussion about the risks and benefits of lung cancer screening. Conclusion PCPs and pulmonary specialists are initiating discussions and ordering LDCT for lung cancer screening. However, a significant proportion of both specialties are still using a non‐recommended screening tool (chest x‐ray); only few PCPs and pulmonary specialists recognized the population at risk for which screening is recommended. Targeted provider education is needed to close the knowledge gap and promote proper implementation of guidelines for lung cancer screening.
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Affiliation(s)
- Imad Bou Akl
- Division of Pulmonary, Department of Internal Medicine, American University of Beirut Faculty of Medicine, Beirut, Lebanon
| | - Nathalie K Zgheib
- Department of Pharmacology and Toxicology, American University of Beirut Faculty of Medicine, Beirut, Lebanon.,Cancer Prevention and Control Program, Naef K. Basile Cancer Institute, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
| | - Maroun Matar
- Division of Pulmonary, Department of Internal Medicine, American University of Beirut Faculty of Medicine, Beirut, Lebanon
| | - Deborah Mukherji
- Cancer Prevention and Control Program, Naef K. Basile Cancer Institute, American University of Beirut, Faculty of Medicine, Beirut, Lebanon.,Division of Hematology Oncology, Department of Internal Medicine, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
| | - Marco Bardus
- Cancer Prevention and Control Program, Naef K. Basile Cancer Institute, American University of Beirut, Faculty of Medicine, Beirut, Lebanon.,Department of Health Promotion and Community Health, American University of Beirut Faculty of Health Sciences, Beirut, Lebanon
| | - Rihab Nasr
- Cancer Prevention and Control Program, Naef K. Basile Cancer Institute, American University of Beirut, Faculty of Medicine, Beirut, Lebanon.,Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut Faculty of Medicine, Beirut, Lebanon
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34
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Mach JC, Omar A, Abujudeh H. Public Health Foundations for Radiology Resident Education: Healthcare Disparities in Radiology. Curr Probl Diagn Radiol 2021; 51:403-407. [PMID: 33838972 DOI: 10.1067/j.cpradiol.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/04/2021] [Accepted: 03/04/2021] [Indexed: 11/22/2022]
Abstract
Increasing recognition within the medical literature and by the Accreditation Council for Graduate Medical Education has been attributed to the need for enhanced resident education on concepts related to public health and health equity. Despite increasing documentation of pervasive inequalities within the scope of radiology, dedicated curricula designed to improve cultural competency and understanding of healthcare disparities among radiology trainees remains sparse. With relatively fewer patient interactions, radiology trainees are particularly susceptible to insufficient contextual awareness of how socioeconomic factors influence patient health and behaviors, physician recommendations, and ultimately clinical outcomes. The purpose of this article is to provide a high-yield background of foundational health equity and disparity concepts for radiology trainees, from which additional educational curricula may be derived. Specifically, this article will discuss the fundamental socioeconomic factors known to contribute to discrepant access and use of imaging services, followed by areas in radiology with well-documented disparities of which trainees should be aware. Lastly, previous and current strategies for addressing disparities in radiology will be discussed with the ultimate goal of stimulating trainee participation and the development of novel approaches.
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Affiliation(s)
- John C Mach
- Department of Radiology, Detroit Medical Center, Wayne State University, Detroit, MI..
| | - Abdillahi Omar
- Department of Radiology, Detroit Medical Center, Wayne State University, Detroit, MI
| | - Hani Abujudeh
- Department of Radiology, Detroit Medical Center, Wayne State University, Detroit, MI
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Shah M, Surapaneni PK, Sandhu K, Shafi S, Abe T, Jain S, Oprea G, Volcy J. Assessment and Efficacy of Low-Dose CT Screening and Primary Care Providers Perspective on Lung Cancer Screening: An Institutional Review. Cureus 2021; 13:e13778. [PMID: 33842154 PMCID: PMC8029595 DOI: 10.7759/cureus.13778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 11/05/2022] Open
Abstract
Lung cancer is the most common cause of death in both men and women. The United States Preventive Services Task Force (USPSTF) recommends annual lung screening with low-dose computed tomography (LDCT) chest for individuals aged 55-80 who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. We reviewed the electronic medical records of patients visiting our outpatient clinic over a period of one year. We included all eligible individuals according to USPSTF guidelines for LDCT to identify screening rates at our institution. All primary care physicians, including residents and attendings, were given a prepared questionnaire to understand their beliefs and concerns with the implementation of this program. A total of 13,500 patients visited the outpatient clinic and 1178 were eligible for LDCT. Forty-five percent (45%) of patients received LDCT screening, which was higher than the national average of 2%-5%. A total of 50 primary care providers were included in the survey. The majority of the providers were aware of the USPSTF guidelines and believed that patients with multiple comorbidities and insurance issues were barriers in initiating LDCT screening. Lung cancer screening is an important component in cancer preventive strategies. Widespread awareness among the primary care providers and the public is extremely necessary for improving the use of LDCT.
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Affiliation(s)
- Manan Shah
- Internal Medicine, Morehouse School of Medicine, Atlanta, USA
| | | | - Kirat Sandhu
- Internal Medicine, Morehouse School of Medicine, Atlanta, USA
| | - Saba Shafi
- Pathology and Laboratory Medicine, Yale School of Medicine, New Haven, USA
| | - Temidayo Abe
- Internal Medicine, Morehouse School of Medicine, Atlanta, USA
| | - Sanjay Jain
- Hematology and Medical Oncology, Morehouse School of Medicine, Atlanta, USA
| | - Gabriela Oprea
- Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, USA
| | - Judith Volcy
- Internal Medicine, Morehouse School of Medicine, Atlanta, USA
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Robotic-Assisted Navigation Bronchoscopy as a Paradigm Shift in Peripheral Lung Access. Lung 2021; 199:177-186. [PMID: 33547938 DOI: 10.1007/s00408-021-00421-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The sensitivity of suspicious lung nodules biopsied by currently available techniques is suboptimal. Robotic-assisted navigation bronchoscopy (RANB) is a novel method for biopsying lung nodules. Our study objective was to determine the sensitivity for malignancy and overall diagnostic accuracy for RANB when combined with cone beam CT (CBCT) for secondary confirmation. METHODS 52 consecutive patients were prospectively enrolled. Demographic data, nodule characteristics, procedural information, and follow-up results were obtained. RESULTS Mean patient age was 66, with the majority Caucasian (73%) females (65%) with a similar number of never (46%) and former (46%) smokers. 15 patients had a history of cancer and 3 had a prior thoracic surgery. 59 total nodules were included as 7 patients had two nodules biopsied. Mean nodule diameter was < 2 cm in all dimension with the majority solid (41, 70%) and located in the upper lobes (left: 22, 37%; right: 17, 29%). Bronchus sign was absent (32, 54%) or present (27, 46%) in a similar number. All nodules were successfully reached with nine (15%) requiring minor directional changes after initial cone beam CT. A tissue diagnosis was obtained in 83% (49/59) of biopsied nodules, with malignancy (31, 65%) most common. Including all biopsy results and follow-up imaging, we obtained an 84% (31/37) procedural sensitivity for malignancy and an overall 86% (51/59) diagnostic yield. CONCLUSION RANB with CBCT increases sensitivity for malignancy and diagnostic accuracy of lung nodule biopsies. Combining these modalities has the potential to shift the diagnostic approach to pulmonary nodules.
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Nishi SPE, Lowenstein LM, Mendoza TR, Lopez Olivo MA, Crocker LC, Sepucha K, Niu J, Volk RJ. Shared Decision-Making for Lung Cancer Screening: How Well Are We "Sharing"? Chest 2021; 160:330-340. [PMID: 33556362 DOI: 10.1016/j.chest.2021.01.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 01/08/2021] [Accepted: 01/18/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Lung cancer screening (LCS) reduces lung cancer mortality, but it also carries a range of risks. Shared decision-making (SDM) is a process of engaging patients in their health care decisions and is a vital component of LCS. RESEARCH QUESTION What is the quality of SDM among patients recently assessed for LCS? STUDY DESIGN AND METHODS Cross-sectional study of screened patients recruited from two academic tertiary care centers in the South Central Region of the United States. Self-reported surveys assessed patient demographics, values related to outcomes of LCS, knowledge, SDM components including receipt of educational materials, and decisional conflict. RESULTS Recently screened patients (n = 266) possessed varied LCS knowledge, answering an average of 41.4% of questions correctly. Patients valued finding cancer early over concerns about harms. Patients indicated that LCS benefits were presented to them by a health care provider far more often than harms (68.3% vs 20.8%, respectively), and 30.7% reported they received educational materials about LCS during the screening process. One-third of patients had some decisional conflict (33.6%) related to their screening decisions, whereas most patients (86.6%) noted that they were involved in the screening decision as much as they wanted. In multivariate models, non-White race and having less education were related to lower knowledge scores. Non-White patients and former smokers were more likely to be conflicted about the screening decision. Most patients (n = 227 [85.3%]) indicated that a health care provider had discussed smoking cessation or abstinence with them. INTERPRETATION Among recently screened patients, the quality of decision-making about LCS is highly variable. The low use of educational materials including decision aids and imbalance of conveying benefit vs risk information to patients is concerning. A structured approach using decision aids may assist with providing a balanced presentation of information and may improve the quality of SDM.
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Affiliation(s)
- Shawn P E Nishi
- Department of Internal Medicine, Division of Pulmonary Critical Care and Sleep Medicine, The University of Texas Medical Branch, Galveston, TX.
| | - Lisa M Lowenstein
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tito R Mendoza
- Department of Symptom Research, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Maria A Lopez Olivo
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Laura C Crocker
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Karen Sepucha
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jiangong Niu
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robert J Volk
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX
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Lopez-Olivo MA, Minnix JA, Fox JG, Nishi SPE, Lowenstein LM, Maki KG, Leal VB, Tina Shih YC, Cinciripini PM, Volk RJ. Smoking cessation and shared decision-making practices about lung cancer screening among primary care providers. Cancer Med 2021; 10:1357-1365. [PMID: 33463091 PMCID: PMC7926026 DOI: 10.1002/cam4.3714] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/02/2020] [Accepted: 12/10/2020] [Indexed: 11/18/2022] Open
Abstract
Objective We describe primary care providers’ current practice patterns related to smoking cessation counseling and lung cancer screening (LCS). Methods Family, internal medicine, and pulmonary medicine providers from two medical centers were asked to complete an electronic survey to report their practice patterns. Results Of 52 participating providers, most reported initiating three major components of a smoking cessation intervention often or very often: advise to quit (50, 96%), assess willingness to quit (47, 90%), and assist with counseling or pharmacotherapy (49, 94%). However, other components were less commonly initiated such as arranging follow‐ups (only 11 providers indicated recommending them often or very often, 21%) and less than half of providers reported that they often or very often recommend cessation counseling or pharmacotherapy of any type (except varenicline), though family medicine providers were more likely to recommend pharmacotherapy compared to the other specialists (p < 0.01). The majority of providers (47, 92%) reported that they engage in informed/shared decision‐making about LCS, although only about one‐third (17, 33%) indicated using a patient decision aid. Pulmonary medicine providers were more likely to use decision aids than providers from internal or family medicine (p < 0.04). Conclusions Within the context of LCS, primary care providers report often having conversations about smoking cessation with their patients who smoke, have no clear preference for type of treatment, and rarely use follow‐up calls or visits pertaining to quitting smoking. While many providers report engaging in shared decision‐making about LCS, few use a decision aid for this conversation.
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Affiliation(s)
- Maria A Lopez-Olivo
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer A Minnix
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - James G Fox
- Division of Pulmonary & Critical Care Medicine, The University of Texas, Health East Texas, Tyler, TX, USA
| | - Shawn P E Nishi
- Division of Pulmonary & Critical Care Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Lisa M Lowenstein
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kristin G Maki
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Viola B Leal
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paul M Cinciripini
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Watson L, Cotter MM, Shafer S, Neloms K, Smith RA, Sharpe K. Implementation of a Lung Cancer Screening Program in Two Federally Qualified Health Centers. Public Health Rep 2021; 136:397-402. [PMID: 33440129 DOI: 10.1177/0033354920971717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Using low-dose computed tomography (LDCT) to screen for lung cancer is associated with improved outcomes among eligible current and former smokers (ie, aged 55-77, at least 30-pack-year smoking history, current smoker or former smoker who quit within the past 15 years). However, the overall uptake of LDCT is low, especially in health care settings with limited personnel and financial resources. To increase access to lung cancer screening services, the American Cancer Society partnered with 2 federally qualified health centers (FQHCs) in Tennessee and West Virginia to conduct a pilot project focused on developing and refining the LDCT screening referral processes and practices. Each FQHC was required to partner with an American College of Radiology-designated lung cancer screening center in its area to ensure high-quality patient care. The pilot project was conducted in 2 phases: 6 months of capacity building (January-June 2016) followed by 2 years of implementation (July 2016-June 2018). One site created a sustainable LDCT referral program, and the other site encountered numerous barriers and failed to overcome them. This case study highlights implementation barriers and factors associated with success and improved outcomes in LDCT screening.
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Affiliation(s)
- Lesley Watson
- 1369 Advocacy Analytics and Impact Communications, American Cancer Society Cancer Action Network, Atlanta, GA, USA.,Current affiliation: Public Health, NORC at the University of Chicago, Chicago, IL, USA
| | - Megan M Cotter
- 1369 Population Sciences, American Cancer Society, Atlanta, GA, USA
| | - Shauna Shafer
- 1369 State and Primary Care Systems, American Cancer Society, Atlanta, GA, USA
| | - Kara Neloms
- 1369 State and Primary Care Systems, American Cancer Society, Atlanta, GA, USA
| | - Robert A Smith
- 1369 Cancer Screening, American Cancer Society, Atlanta, GA, USA
| | - Katherine Sharpe
- 1369 Patient and Caregiver Support, American Cancer Society, Atlanta, GA, USA
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Rodríguez-Rabassa MS, Simmons VN, Vega A, Moreno D, Irizarry-Ramos J, Quinn GP. Perceptions of and Barriers to Lung Cancer Screening Among Physicians in Puerto Rico: A Qualitative Study. J Health Care Poor Underserved 2021; 31:973-991. [PMID: 33410819 DOI: 10.1353/hpu.2020.0072] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Low-dose computed tomography (LDCT), an accepted U.S. screening tool for early lung cancer detection, is not widely-used in Puerto Rico. We investigated knowledge and attitudes about LDCT in focus groups of primary care physicians (PCP) and individuals at high risk for lung cancer (HRI) in Puerto Rico. Transcribed/translated audio-recorded discussions were analyzed with the constant comparison method. Both groups had limited knowledge about LDCT and concerns regarding insurance coverage. Most HRIs had never had a provider recommend LDCT and believed that having symptoms was necessary to obtain LDCT screening. Perceived barriers included fears about results and the procedure; a perceived benefit was having early detection and possibly being cured. Few PCPs had ever recommended LDCT to a patient, with those who had basing their decision on symptoms/smoking history but having challenges with insurance. More education on LDCT is needed among HRIs, and U.S. Preventive Services Task Force guidelines should be widely distributed to encourage physician recommendations.
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Olazagasti C, Seetharamu N. Disparities in Lung Cancer Screening in Puerto Rico: A United States Colony with Unequal Benefits. Cancer Control 2021; 28:10732748211051924. [PMID: 34676787 PMCID: PMC8543552 DOI: 10.1177/10732748211051924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Coral Olazagasti
- Division of Hematology-Oncology at Zucker School of Medicine at Hofstra/Northwell Health, New Hyde Park, NY, USA
| | - Nagashree Seetharamu
- Division of Hematology-Oncology at Zucker School of Medicine at Hofstra/Northwell Health, New Hyde Park, NY, USA
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Gerber DE, Hamann HA, Dorsey O, Ahn C, Phillips JL, Santini NO, Browning T, Ochoa CD, Adesina J, Natchimuthu VS, Steen E, Majeed H, Gonugunta A, Lee SJC. Clinician Variation in Ordering and Completion of Low-Dose Computed Tomography for Lung Cancer Screening in a Safety-Net Medical System. Clin Lung Cancer 2020; 22:e612-e620. [PMID: 33478912 DOI: 10.1016/j.cllc.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 11/19/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Less than 5% of eligible individuals in the United States undergo lung cancer screening. Variation in clinicians' participation in lung cancer screening has not been determined. PATIENTS AND METHODS We studied medical providers who ordered ≥ 1 low-dose computed tomography (LDCT) for lung cancer screening from February 2017 through February 2019 in an integrated safety-net healthcare system. We analyzed associations between provider characteristics and LDCT orders and completion using chi-square, Fisher exact, and Student t tests, as well as ANOVA and multinomial logistic regression. RESULTS Among an estimated 194 adult primary care physicians, 144 (74%) ordered at least 1 LDCT, as did 39 specialists. These 183 medical providers ordered 1594 LDCT (median, 4; interquartile range, 2-9). In univariate and multivariate models, family practice providers (P < .001) and providers aged ≥ 50 years (P = .03) ordered more LDCT than did other clinicians. Across providers, the median proportion of ordered LDCT that were completed was 67%. The total or preceding number of LDCT ordered by a clinician was not associated with the likelihood of LDCT completion. CONCLUSION In an integrated safety-net healthcare system, most adult primary care providers order LDCT. The number of LDCT ordered varies widely among clinicians, and a substantial proportion of ordered LDCT are not completed.
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Affiliation(s)
- David E Gerber
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX; Division of Hematology-Oncology, UT Southwestern Medical Center, Dallas, TX; Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX.
| | - Heidi A Hamann
- Departments of Psychology and Family and Community Medicine, University of Arizona, Tucson, AZ
| | - Olivia Dorsey
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX
| | - Chul Ahn
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX; Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | - Jessica L Phillips
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX
| | - Noel O Santini
- Parkland Health and Hospital System, Dallas, TX; Division of General Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Travis Browning
- Parkland Health and Hospital System, Dallas, TX; Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Cristhiaan D Ochoa
- Parkland Health and Hospital System, Dallas, TX; Division of Pulmonary and Critical Care Medicine, UT Southwestern Medical Center, Dallas, TX
| | | | | | - Eric Steen
- Parkland Health and Hospital System, Dallas, TX; Division of General Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Harris Majeed
- School of Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Amrit Gonugunta
- School of Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Simon J Craddock Lee
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX; Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
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Rivera MP, Katki HA, Tanner NT, Triplette M, Sakoda LC, Wiener RS, Cardarelli R, Carter-Harris L, Crothers K, Fathi JT, Ford ME, Smith R, Winn RA, Wisnivesky JP, Henderson LM, Aldrich MC. Addressing Disparities in Lung Cancer Screening Eligibility and Healthcare Access. An Official American Thoracic Society Statement. Am J Respir Crit Care Med 2020; 202:e95-e112. [PMID: 33000953 PMCID: PMC7528802 DOI: 10.1164/rccm.202008-3053st] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: There are well-documented disparities in lung cancer outcomes across populations. Lung cancer screening (LCS) has the potential to reduce lung cancer mortality, but for this benefit to be realized by all high-risk groups, there must be careful attention to ensuring equitable access to this lifesaving preventive health measure.Objectives: To outline current knowledge on disparities in eligibility criteria for, access to, and implementation of LCS, and to develop an official American Thoracic Society statement to propose strategies to optimize current screening guidelines and resource allocation for equitable LCS implementation and dissemination.Methods: A multidisciplinary panel with expertise in LCS, implementation science, primary care, pulmonology, health behavior, smoking cessation, epidemiology, and disparities research was convened. Participants reviewed available literature on historical disparities in cancer screening and emerging evidence of disparities in LCS.Results: Existing LCS guidelines do not consider racial, ethnic, socioeconomic, and sex-based differences in smoking behaviors or lung cancer risk. Multiple barriers, including access to screening and cost, further contribute to the inequities in implementation and dissemination of LCS.Conclusions: This statement identifies the impact of LCS eligibility criteria on vulnerable populations who are at increased risk of lung cancer but do not meet eligibility criteria for screening, as well as multiple barriers that contribute to disparities in LCS implementation. Strategies to improve the selection and dissemination of LCS in vulnerable groups are described.
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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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Raju S, Khawaja A, Han X, Wang X, Mazzone PJ. Lung Cancer Screening: Characteristics of Nonparticipants and Potential Screening Barriers. Clin Lung Cancer 2020; 21:e329-e336. [DOI: 10.1016/j.cllc.2019.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/11/2019] [Accepted: 11/22/2019] [Indexed: 10/24/2022]
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Watson KS, Siegel LD, Henderson VA, Murray M, Chukwudozie IB, Odell D, Stinson J, Ituah O, Ben Levi J, Fitzgibbon ML, Kim S, Matthews P. The SHARED Project: A Novel Approach to Engaging African American Men to Address Lung Cancer Disparities. Am J Mens Health 2020; 14:1557988320958934. [PMID: 32938277 PMCID: PMC7503018 DOI: 10.1177/1557988320958934] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 08/17/2020] [Accepted: 08/25/2020] [Indexed: 01/03/2023] Open
Abstract
Black men are disproportionately impacted by lung cancer morbidity and mortality. Low-dose helical computed tomography (LDCT) lung cancer screening has demonstrated benefits for reducing lung cancer deaths by identifying cancers at earlier, more treatable stages. Despite the known benefits, LDCT screening is underutilized in black men. Studies in racially heterogeneous populations have found correlations between screening behaviors and factors such as physician trust, physician referral, and a desire to reduce the uncertainty of not knowing if they had lung cancer; yet little is known about the factors that specifically contribute to screening behaviors in black men. Community engagement strategies are beneficial for understanding barriers to health-care engagement. One community engagement approach is the citizen scientist model. Citizen scientists are lay people who are trained in research methods; they have proven valuable in increasing communities' knowledge of the importance of healthy behaviors such as screening, awareness of research, building trust in research, and improving study design and ethics. This paper proposes an intervention, grounded in community-based participatory research approaches and social network theory, to engage black men as citizen scientists in an effort to increase lung cancer screening in black men. This mixed-methods intervention will examine the attitudes, behaviors, and beliefs of black men related to uptake of evidence-based lung cancer screening.
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Affiliation(s)
- Karriem S. Watson
- UI Cancer Center, University of Illinois, Chicago, IL, USA
- Mile Square Health Center, UI Health, Chicago, IL, USA
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Leilah D. Siegel
- UI Cancer Center, University of Illinois, Chicago, IL, USA
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Vida A. Henderson
- UI Cancer Center, University of Illinois, Chicago, IL, USA
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | | | | | - David Odell
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - James Stinson
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
- Department of Urology, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Ose Ituah
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Josef Ben Levi
- College of Education, Northeastern Illinois University, Chicago, IL, USA
| | - Marian L. Fitzgibbon
- UI Cancer Center, University of Illinois, Chicago, IL, USA
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Sage Kim
- UI Cancer Center, University of Illinois, Chicago, IL, USA
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Phoenix Matthews
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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Golden SE, Ono SS, Thakurta SG, Wiener RS, Iaccarino JM, Melzer AC, Datta SK, Slatore CG. “I’m Putting My Trust in Their Hands”. Chest 2020; 158:1260-1267. [DOI: 10.1016/j.chest.2020.02.072] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 12/17/2022] Open
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Lewis JA, Chen H, Weaver KE, Spalluto LB, Sandler KL, Horn L, Dittus RS, Massion PP, Roumie CL, Tindle HA. Low Provider Knowledge Is Associated With Less Evidence-Based Lung Cancer Screening. J Natl Compr Canc Netw 2020; 17:339-346. [PMID: 30959463 DOI: 10.6004/jnccn.2018.7101] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/22/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite widespread recommendation and supportive policies, screening with low-dose CT (LDCT) is incompletely implemented in the US healthcare system. Low provider knowledge of the lung cancer screening (LCS) guidelines represents a potential barrier to implementation. Therefore, we tested the hypothesis that low provider knowledge of guidelines is associated with less provider-reported screening with LDCT. PATIENTS AND METHODS A cross-sectional survey was performed in a large academic medical center and affiliated Veterans Health Administration in the Mid-South United States that comprises hospital and community-based practices. Participants included general medicine providers and specialists who treat patients aged >50 years. The primary exposure was LCS guideline knowledge (US Preventive Services Task Force/Centers for Medicare & Medicaid Services). High knowledge was defined as identifying 3 major screening eligibility criteria (55 years as initial age of screening eligibility, smoking status as current or former smoker, and smoking history of ≥30 pack-years), and low knowledge was defined as not identifying these 3 criteria. The primary outcome was self-reported LDCT order/referral within the past year, and the secondary outcome was screening chest radiograph. Multivariable logistic regression evaluated the adjusted odds ratio (aOR) of screening by knowledge. RESULTS Of 625 providers recruited, 407 (65%) responded, and 378 (60.5%) were analyzed. Overall, 233 providers (62%) demonstrated low LCS knowledge, and 224 (59%) reported ordering/referring for LDCT. The aOR of ordering/referring LDCT was less among providers with low knowledge (0.41; 95% CI, 0.24-0.71) than among those with high knowledge. More providers with low knowledge reported ordering screening chest radiographs (aOR, 2.7; 95% CI, 1.4-5.0) within the past year. CONCLUSIONS Referring provider knowledge of LCS guidelines is low and directly proportional to the ordering rate for LDCT in an at-risk US population. Strategies to advance evidence-based LCS should incorporate provider education and system-level interventions to address gaps in provider knowledge.
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Affiliation(s)
- Jennifer A Lewis
- aGeriatric Research, Education and Clinical Center, Veterans Health Administration - Tennessee Valley Healthcare System, Nashville, Tennessee.,bDivision of Hematology/Oncology, Department of Medicine, and
| | - Heidi Chen
- cDepartment of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kathryn E Weaver
- dDepartment of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lucy B Spalluto
- aGeriatric Research, Education and Clinical Center, Veterans Health Administration - Tennessee Valley Healthcare System, Nashville, Tennessee.,eDepartment of Radiology
| | | | - Leora Horn
- bDivision of Hematology/Oncology, Department of Medicine, and
| | - Robert S Dittus
- aGeriatric Research, Education and Clinical Center, Veterans Health Administration - Tennessee Valley Healthcare System, Nashville, Tennessee.,fDivision of General Internal Medicine and Public Health, Department of Medicine, and
| | - Pierre P Massion
- gDivision of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; and.,hDepartment of Medicine, Veterans Health Administration - Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Christianne L Roumie
- aGeriatric Research, Education and Clinical Center, Veterans Health Administration - Tennessee Valley Healthcare System, Nashville, Tennessee.,fDivision of General Internal Medicine and Public Health, Department of Medicine, and
| | - Hilary A Tindle
- aGeriatric Research, Education and Clinical Center, Veterans Health Administration - Tennessee Valley Healthcare System, Nashville, Tennessee.,fDivision of General Internal Medicine and Public Health, Department of Medicine, and
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49
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Hochheimer CJ, Sabo RT, Tong ST, Westfall M, Wolver SE, Carney S, Day T, Krist AH. Practice, clinician, and patient factors associated with the adoption of lung cancer screening. J Med Screen 2020; 28:158-162. [PMID: 32605509 DOI: 10.1177/0969141320937326] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Lung cancer remains the leading cause of cancer-related deaths in the United States. In 2013, the US Preventive Services Task Force recommended annual screening for lung cancer with low-dose computed tomography in adults meeting certain criteria. This study seeks to assess lung cancer screening uptake in three health systems. SETTING This study was part of a randomized controlled trial to engage underserved populations in preventive care and includes 45 primary care practices in eight states. METHODS Practice and clinician characteristics were manually collected. Lung cancer was measured from electronic health record data. A generalized linear mixed model was used to assess characteristics associated with screening. RESULTS Patient records between 2012 and 2016 were examined. Lung cancer screening uptake overall increased only slightly after the guideline change (2.8-5.6%, p < 0.01). One health system did not show an increase in uptake (0.2-0.1%, p = 0.32), another had a clinically insignificant increase (1.5-2.9%, p < 0.01), and the third nearly doubled its higher baseline screening rate (10.4-19.1%, p < 0.01). Within the third health system, patients more likely to be screened were older, male, had more comorbid conditions, visited the office more frequently, were seen in practices closer to the screening clinic, or were uninsured or covered by Medicare or Medicaid. CONCLUSIONS Certain patients appeared more likely to be screened. The only health system with increased lung cancer screening explicitly promoted screening rather than relying on clinicians to implement the new guideline. Systems approaches may help increase the low uptake of lung cancer screening.
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Affiliation(s)
- Camille J Hochheimer
- Department of Public Health Sciences, University of Virginia, Charlottesville, USA
| | - Roy T Sabo
- Department of Biostatistics, Virginia Commonwealth University, Richmond, USA.,Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, USA
| | - Sebastian T Tong
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, USA
| | - Matthew Westfall
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, USA
| | - Susan E Wolver
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, USA
| | | | - Teresa Day
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, USA
| | - Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, USA.,Fairfax Family Practice Residency, Fairfax, USA
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50
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Olazagasti C, Bernabe C, Seetharamu N. Lung cancer screening guidelines are clear but are they being followed? Lung Cancer Manag 2020; 9:LMT35. [PMID: 33318756 PMCID: PMC7724650 DOI: 10.2217/lmt-2020-0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Coral Olazagasti
- Department of Medicine, Division of Hematology & Medical Oncology, Barbara & Donald Zucker School of Medicine at Hofstra/Northwell Health Hempstead, NY 11549, USA
| | - Carolina Bernabe
- Division of Hematology & Medical Oncology at Essen Medical Associates, Bronx, NY 10452, USA
| | - Nagashree Seetharamu
- Department of Medicine, Division of Hematology & Medical Oncology, Barbara & Donald Zucker School of Medicine at Hofstra/Northwell Health Hempstead, NY 11549, USA
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