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Wainwright JV, Aggarwal C, Beucker S, Dougherty DW, Gabriel PE, Jacobs LA, Kalman J, Linn KA, Martella AO, Mehta SJ, Rhodes CM, Roy M, Schapira MM, Shulman LN, Steltz J, Stephens Shields AJ, Tan ASL, Thompson JC, Toneff H, Wender RC, Zeb S, Rendle KA, Vachani A, Bekelman JE. University of Pennsylvania Telehealth Research Center of Excellence. J Natl Cancer Inst Monogr 2024; 2024:62-69. [PMID: 38924794 PMCID: PMC11207744 DOI: 10.1093/jncimonographs/lgae011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/17/2024] [Accepted: 02/16/2024] [Indexed: 06/28/2024] Open
Abstract
Drawing from insights from communication science and behavioral economics, the University of Pennsylvania Telehealth Research Center of Excellence (Penn TRACE) is designing and testing telehealth strategies with the potential to transform access to care, care quality, outcomes, health equity, and health-care efficiency across the cancer care continuum, with an emphasis on understanding mechanisms of action. Penn TRACE uses lung cancer care as an exemplar model for telehealth across the care continuum, from screening to treatment to survivorship. We bring together a diverse and interdisciplinary team of international experts and incorporate rapid-cycle approaches and mixed methods evaluation in all center projects. Our initiatives include a pragmatic sequential multiple assignment randomized trial to compare the effectiveness of telehealth strategies to increase shared decision-making for lung cancer screening and 2 pilot projects to test the effectiveness of telehealth to improve cancer care, identify multilevel mechanisms of action, and lay the foundation for future pragmatic trials. Penn TRACE aims to produce new fundamental knowledge and advance telehealth science in cancer care at Penn and nationally.
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Affiliation(s)
- Jocelyn V Wainwright
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
| | - Charu Aggarwal
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah Beucker
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
| | - David W Dougherty
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter E Gabriel
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Linda A Jacobs
- Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Jillian Kalman
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristin A Linn
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anthony O Martella
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Shivan J Mehta
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Corinne M Rhodes
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Megan Roy
- Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Marilyn M Schapira
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Lawrence N Shulman
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer Steltz
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alisa J Stephens Shields
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andy S L Tan
- Annenberg School for Communications, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey C Thompson
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hannah Toneff
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
| | - Richard C Wender
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sana Zeb
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Katharine A Rendle
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anil Vachani
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Justin E Bekelman
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Herbst AN, McCullough MB, Wiener RS, Barker AM, Maguire EM, Fix GM. Proactively tailoring implementation: the case of shared decision-making for lung cancer screening across the VA New England Healthcare Network. BMC Health Serv Res 2023; 23:1282. [PMID: 37993840 PMCID: PMC10664378 DOI: 10.1186/s12913-023-10245-9] [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: 04/13/2023] [Accepted: 10/30/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Shared Decision-Making to discuss how the benefits and harms of lung cancer screening align with patient values is required by the US Centers for Medicare and Medicaid and recommended by multiple organizations. Barriers at organizational, clinician, clinical encounter, and patient levels prevent SDM from meeting quality standards in routine practice. We developed an implementation plan, using the socio-ecological model, for Shared Decision-Making for lung cancer screening for the Department of Veterans Affairs (VA) New England Healthcare System. Because understanding the local context is critical to implementation success, we sought to proactively tailor our original implementation plan, to address barriers to achieving guideline-concordant lung cancer screening. METHODS We conducted a formative evaluation using an ethnographic approach to proactively identify barriers to Shared Decision-Making and tailor our implementation plan. Data consisted of qualitative interviews with leadership and clinicians from seven VA New England medical centers, regional meeting notes, and Shared Decision-Making scripts and documents used by providers. Tailoring was guided by the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS). RESULTS We tailored the original implementation plan to address barriers we identified at the organizational, clinician, clinical encounter, and patient levels. Overall, we removed two implementation strategies, added five strategies, and modified the content of two strategies. For example, at the clinician level, we learned that past personal and clinical experiences predisposed clinicians to focus on the benefits of lung cancer screening. To address this barrier, we modified the content of our original implementation strategy Make Training Dynamic to prompt providers to self-reflect about their screening beliefs and values, encouraging them to discuss both the benefits and potential harms of lung cancer screening. CONCLUSIONS Formative evaluations can be used to proactively tailor implementation strategies to fit local contexts. We tailored our implementation plan to address unique barriers we identified, with the goal of improving implementation success. The FRAME-IS aided our team in thoughtfully addressing and modifying our original implementation plan. Others seeking to maximize the effectiveness of complex interventions may consider using a similar approach.
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Affiliation(s)
- Abigail N Herbst
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
| | - Megan B McCullough
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
- Department of Public Health, Zuckerberg School of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC, US, USA
- The Pulmonary Center, Boston University Chobanian &, Avedisian School of Medicine, Boston, MA, USA
| | - Anna M Barker
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
| | - Elizabeth M Maguire
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
| | - Gemmae M Fix
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA.
- General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
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Mankidy BJ, Mohammad G, Trinh K, Ayyappan AP, Huang Q, Bujarski S, Jafferji MS, Ghanta R, Hanania AN, Lazarus DR. High risk lung nodule: A multidisciplinary approach to diagnosis and management. Respir Med 2023; 214:107277. [PMID: 37187432 DOI: 10.1016/j.rmed.2023.107277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 05/17/2023]
Abstract
Pulmonary nodules are often discovered incidentally during CT scans performed for other reasons. While the vast majority of nodules are benign, a small percentage may represent early-stage lung cancer with the potential for curative treatments. With the growing use of CT for both clinical purposes and lung cancer screening, the number of pulmonary nodules detected is expected to increase substantially. Despite well-established guidelines, many nodules do not receive proper evaluation due to a variety of factors, including inadequate coordination of care and financial and social barriers. To address this quality gap, novel approaches such as multidisciplinary nodule clinics and multidisciplinary boards may be necessary. As pulmonary nodules may indicate early-stage lung cancer, it is crucial to adopt a risk-stratified approach to identify potential lung cancers at an early stage, while minimizing the risk of harm and expense associated with over investigation of low-risk nodules. This article, authored by multiple specialists involved in nodule management, delves into the diagnostic approach to lung nodules. It covers the process of determining whether a patient requires tissue sampling or continued surveillance. Additionally, the article provides an in-depth examination of the various biopsy and therapeutic options available for malignant lung nodules. The article also emphasizes the significance of early detection in reducing lung cancer mortality, especially among high-risk populations. Furthermore, it addresses the creation of a comprehensive lung nodule program, which involves smoking cessation, lung cancer screening, and systematic evaluation and follow-up of both incidental and screen-detected nodules.
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Affiliation(s)
- Babith J Mankidy
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, 1Baylor Plaza, Houston, TX, 77030, USA.
| | - GhasemiRad Mohammad
- Department of Radiology, Division of Vascular and Interventional Radiology, Baylor College of Medicine, USA.
| | - Kelly Trinh
- Texas Tech University Health Sciences Center, School of Medicine, USA.
| | - Anoop P Ayyappan
- Department of Radiology, Division of Thoracic Radiology, Baylor College of Medicine, USA.
| | - Quillan Huang
- Department of Oncology, Baylor College of Medicine, USA.
| | - Steven Bujarski
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, 1Baylor Plaza, Houston, TX, 77030, USA.
| | | | - Ravi Ghanta
- Department of Cardiothoracic Surgery, Baylor College of Medicine, USA.
| | | | - Donald R Lazarus
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, 1Baylor Plaza, Houston, TX, 77030, USA.
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O'Dowd EL, Lee RW, Akram AR, Bartlett EC, Bradley SH, Brain K, Callister MEJ, Chen Y, Devaraj A, Eccles SR, Field JK, Fox J, Grundy S, Janes SM, Ledson M, MacKean M, Mackie A, McManus KG, Murray RL, Nair A, Quaife SL, Rintoul R, Stevenson A, Summers Y, Wilkinson LS, Booton R, Baldwin DR, Crosbie P. Defining the road map to a UK national lung cancer screening programme. Lancet Oncol 2023; 24:e207-e218. [PMID: 37142382 DOI: 10.1016/s1470-2045(23)00104-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 05/06/2023]
Abstract
Lung cancer screening with low-dose CT was recommended by the UK National Screening Committee (UKNSC) in September, 2022, on the basis of data from trials showing a reduction in lung cancer mortality. These trials provide sufficient evidence to show clinical efficacy, but further work is needed to prove deliverability in preparation for a national roll-out of the first major targeted screening programme. The UK has been world leading in addressing logistical issues with lung cancer screening through clinical trials, implementation pilots, and the National Health Service (NHS) England Targeted Lung Health Check Programme. In this Policy Review, we describe the consensus reached by a multiprofessional group of experts in lung cancer screening on the key requirements and priorities for effective implementation of a programme. We summarise the output from a round-table meeting of clinicians, behavioural scientists, stakeholder organisations, and representatives from NHS England, the UKNSC, and the four UK nations. This Policy Review will be an important tool in the ongoing expansion and evolution of an already successful programme, and provides a summary of UK expert opinion for consideration by those organising and delivering lung cancer screenings in other countries.
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Affiliation(s)
- Emma L O'Dowd
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Richard W Lee
- Early Diagnosis and Detection Centre, National Institute for Health and Care Research Biomedical Research Centre at the Royal Marsden and Institute of Cancer Research, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.
| | - Ahsan R Akram
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK; Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Emily C Bartlett
- Royal Brompton and Harefield Hospitals London and National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Kate Brain
- Division of Population Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | | | - Yan Chen
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Anand Devaraj
- Royal Brompton and Harefield Hospitals London and National Heart and Lung Institute, Imperial College London, London, UK
| | - Sinan R Eccles
- Royal Glamorgan Hospital, Cwm Taf Morgannwg University Health Board, Llantrisant, UK
| | - John K Field
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Jesme Fox
- Roy Castle Lung Cancer Foundation, Liverpool, UK
| | - Seamus Grundy
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Sam M Janes
- Lungs for Living Research Centre, Department of Respiratory Medicine, University College London, London, UK
| | - Martin Ledson
- Department of Respiratory Medicine, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | | | - Kieran G McManus
- Department of Thoracic Surgery, Royal Victoria Hospital, Belfast, UK
| | - Rachael L Murray
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Arjun Nair
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Samantha L Quaife
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Robert Rintoul
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Anne Stevenson
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Yvonne Summers
- The Christie Hospital NHS Trust, Manchester University NHS Foundation Trust, Manchester, UK
| | - Louise S Wilkinson
- Oxford Breast Imaging Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard Booton
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Philip Crosbie
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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5
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Núñez ER, Caverly TJ, Zhang S, Glickman ME, Qian SX, Boudreau JH, Miller DR, Slatore CG, Wiener RS. Factors Associated With Declining Lung Cancer Screening After Discussion With a Physician in a Cohort of US Veterans. JAMA Netw Open 2022; 5:e2227126. [PMID: 35972738 PMCID: PMC9382440 DOI: 10.1001/jamanetworkopen.2022.27126] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Lung cancer screening (LCS) is underused in the US, particularly in underserved populations, and little is known about factors associated with declining LCS. Guidelines call for shared decision-making when LCS is offered to ensure informed, patient-centered decisions. OBJECTIVE To assess how frequently veterans decline LCS and examine factors associated with declining LCS. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included LCS-eligible US veterans who were offered LCS between January 1, 2013, and February 1, 2021, by a physician at 1 of 30 Veterans Health Administration (VHA) facilities that routinely used electronic health record clinical reminders documenting LCS eligibility and veterans' decisions to accept or decline LCS. Data were obtained from the Veterans Affairs (VA) Corporate Data Warehouse or Medicare claims files from the VA Information Resource Center. MAIN OUTCOMES AND MEASURES The main outcome was documentation, in clinical reminders, that veterans declined LCS after a discussion with a physician. Logistic regression analyses with physicians and facilities as random effects were used to assess factors associated with declining LCS compared with agreeing to LCS. RESULTS Of 43 257 LCS-eligible veterans who were offered LCS (mean [SD] age, 64.7 [5.8] years), 95.9% were male, 84.2% were White, and 37.1% lived in a rural zip code; 32.0% declined screening. Veterans were less likely to decline LCS if they were younger (age 55-59 years: odds ratio [OR], 0.69; 95% CI, 0.64-0.74; age 60-64 years: OR, 0.80; 95% CI, 0.75-0.85), were Black (OR, 0.80; 95% CI, 0.73-0.87), were Hispanic (OR, 0.62; 95% CI, 0.49-0.78), did not have to make co-payments (OR, 0.92; 95% CI, 0.85-0.99), or had more frequent VHA health care utilization (outpatient: OR, 0.70; 95% CI, 0.67-0.72; emergency department: OR, 0.86; 95% CI, 0.80-0.92). Veterans were more likely to decline LCS if they were older (age 70-74 years: OR, 1.27; 95% CI, 1.19-1.37; age 75-80 years: OR, 1.93; 95% CI, 1.73-2.17), lived farther from a VHA screening facility (OR, 1.06; 95% CI, 1.03-1.08), had spent more days in long-term care (OR, 1.13; 95% CI, 1.07-1.19), had a higher Elixhauser Comorbidity Index score (OR, 1.04; 95% CI, 1.03-1.05), or had specific cardiovascular or mental health conditions (congestive heart failure: OR, 1.25; 95% CI, 1.12-1.39; stroke: OR, 1.14; 95% CI, 1.01-1.28; schizophrenia: OR, 1.87; 95% CI, 1.60-2.19). The physician and facility offering LCS accounted for 19% and 36% of the variation in declining LCS, respectively. CONCLUSIONS AND RELEVANCE In this cohort study, older veterans with serious comorbidities were more likely to decline LCS and Black and Hispanic veterans were more likely to accept it. Variation in LCS decisions was accounted for more by the facility and physician offering LCS than by patient factors. These findings suggest that shared decision-making conversations in which patients play a central role in guiding care may enhance patient-centered care and address disparities in LCS.
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Affiliation(s)
- Eduardo R. Núñez
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
| | - Tanner J. Caverly
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- University of Michigan Medical School, Ann Arbor
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC
| | - Sanqian Zhang
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
- Department of Statistics, Harvard University, Cambridge, Massachusetts
| | - Mark E. Glickman
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC
| | - Shirley X. Qian
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
| | - Jacqueline H. Boudreau
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
| | - Donald R. Miller
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
| | - Christopher G. Slatore
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon
- Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland
| | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC
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Bujarski S, Flowers R, Alkhunaizi M, Cuvi D, Sathya S, Melcher J, Kheradmand F, Holt G. Challenges in initiating a lung cancer screening program: Experiences from two VA medical centers. Semin Oncol 2022; 49:S0093-7754(22)00046-X. [PMID: 35853765 DOI: 10.1053/j.seminoncol.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 11/11/2022]
Abstract
Establishing a lung cancer screening (LCS) program is an important endeavor that delivers life-saving healthcare to an at-risk population. However, developing a comprehensive LCS program requires critical elements including obtaining institutional level buy-in, hiring necessary personnel, developing appropriate infrastructure and actively engaging primary care providers, subspecialty services, and radiology. The process required to connect such services to deliver an organized LCS program that reaches all eligible candidates must be individualized to each institution's needs and infrastructure. Here we provide detailed experiences from two successful LCS programs, one using a primary care provider-based service and the other using a consult-based service. In each case, we provide the pros and cons of each system. We propose that the decision to setup an ideal LCS program could include a hybrid design that combines aspects of each system.
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Affiliation(s)
- Stephen Bujarski
- Section of Pulmonary, Critical Care and Sleep Medicine, Michael E. DeBakey VA Medical Center, Houston TX, USA; Department of Medicine, Baylor College of Medicine, Houston TX, USA.
| | - Robert Flowers
- Department of Medicine, Jackson Memorial Hospital, University of Miami, Miami, FL, USA
| | | | - Dave Cuvi
- Division of Pulmonology, Department of Medicine, Miami VA Medical Center, Miami, FL, USA
| | - Sneha Sathya
- Division of Pulmonary, Allergy Critical Care and Sleep Medicine, Department of Medicine, University of Miami, Miami, FL, USA
| | - Jennifer Melcher
- Lung Precision Oncology Program, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Farrah Kheradmand
- Section of Pulmonary, Critical Care and Sleep Medicine, Michael E. DeBakey VA Medical Center, Houston TX, USA; Department of Medicine, Baylor College of Medicine, Houston TX, USA
| | - Gregory Holt
- Division of Pulmonology, Department of Medicine, Miami VA Medical Center, Miami, FL, USA; Division of Pulmonary, Allergy Critical Care and Sleep Medicine, Department of Medicine, University of Miami, Miami, FL, USA
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7
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Lewis JA, Wiener RS, Slatore CG, Spalluto LB. Doing Versus Documenting Shared Decision Making for Lung Cancer Screening-Are They the Same? J Am Coll Radiol 2022; 19:954-956. [PMID: 35594952 PMCID: PMC10285710 DOI: 10.1016/j.jacr.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Jennifer A Lewis
- Veterans' Health Administration, Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center and Medicine Service, Nashville, Tennessee; Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Steering Committee; Tennessee Valley Healthcare System Lung Cancer Screening Program; Co-Director, Clinical Lung Cancer Screening Program; and Founding Board Member of the Rescue Lung Rescue Life Society.
| | - Renda Soylemez Wiener
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts; and The Pulmonary Center, Boston University Medical Center, Boston, Massachusetts
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care, Health Services Research and Development, Portland Veterans Affairs Medical Center, Portland, Oregon; Section of Pulmonary and Critical Care Medicine, Portland Veterans Affairs Medical Center, Portland, Oregon; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, Oregon; Co-Director of the Lung Cancer Screening Program; and Chief Consultant, VA National Center for Lung Cancer Screening
| | - Lucy B Spalluto
- Veterans' Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center, Nashville, Tennessee; Vice Chair, Health Equity, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; and Steering Committee, Tennessee Valley Healthcare System Lung Cancer Screening Program
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