An Assessment of Primary Care and Pulmonary Provider Perspectives on Lung Cancer Screening

Abstract

Rationale: Lung cancer screening has a mortality benefit to high-risk smokers, but implementation remains suboptimal. Providers represent the key entry point to screening, and an understanding of provider perspectives on lung cancer screening is necessary to improve referral and overall implementation.

Objectives: The objective of this study was to understand knowledge, beliefs, attitudes, barriers, and facilitators to screening in a diverse group of referring pulmonologists and primary care providers.

Methods: We conducted an electronic survey of primary care and pulmonary providers within a tertiary care medical center across different practice sites. The survey covered the following domains: 1) beliefs and assessment of evidence, 2) knowledge of lung cancer screening and guidelines, 3) current screening practices, 4) barriers and facilitators, and 5) demographic and practice characteristics.

Results: The 196 participants included 80% primary care clinicians and 19% pulmonologists (1% others). Forty-one percent practiced at university-based or affiliated clinics, 47% at county hospital-based clinics, and 12% at other or unidentified sites. The majority endorsed lung cancer screening effectiveness (74%); however, performance on knowledge-based assessments of screening eligibility, documentation, and nodule management was suboptimal. Key barriers included inadequate time (36%), inadequate staffing (36%), and patients having too many other illnesses to address screening (38%). Decision aids, which are used at the point of referral, were commonly identified both as important lung cancer screening clinical facilitators (51%) and as provider knowledge facilitators (59%). There were several differences by provider specialty, including primary care providers more frequently reporting time constraints and their patients having too many other illnesses to address screening as significant barriers to lung cancer screening.

Conclusions: Providers endorsed the benefits of lung cancer screening, but there are limitations in provider knowledge of key screening components. The most frequently reported barriers to screening represent a lack of clinical time or resources to address lung cancer screening in clinical practice. Facilitators for nodule management as well as point-of-care referral materials may be helpful in reducing knowledge gaps and the clinical burden of referral. These are all modifiable factors, which could be addressed to increase screening referral. Differences in attitudes and barriers by specialty should also be considered to optimize screening implementation.

Keywords: attitudes of health personnel; early detection of cancer; lung cancer; pulmonary nodule.

Figures

Figure 1.

Provider responses on patient eligibility in five lung cancer screening scenarios. The scenarios presented to participants are listed on the left. The response options included “not eligible,” “eligible,” and “unsure.” The percent of participants with each response is illustrated on the bar graph, as are the correct answers. The proportion of participants by numbers of correct responses to the first four scenarios is illustrated in the vertical bar graph on the right. The final scenario was not included in this summary. We consider the correct response “not eligible,” as a poor surgical candidate should not be screened per U.S. Preventive Services Task Force guidelines; however, this is marked by an * as there is no definitive consensus contained in other guidelines. yo = year old.