Association of a Lung Screening Program Coordinator With Adherence to Annual CT Lung Screening at a Large Academic Institution

Abstract

Background: Detection of early-stage lung cancer improves during subsequent rounds of screening with low-dose CT and potentially leads to saving lives with curative treatment. Therefore, adherence to annual lung screening is important. We hypothesized that adherence to annual screening would increase after hiring of a dedicated program coordinator.

Methods: We performed a mixed-methods study in a retrospective cohort of patients who underwent lung screening at our academic institution between January 1, 2014, and March 31, 2018. Patients with baseline lung screening examinations performed between January 1, 2014, and September 30, 2016, with Lung CT Screening Reporting & Data System 1 or 2 scores and a 12-month follow-up recommendation were included. We tracked patient adherence to annual follow-up lung screening over time (before and after hiring of a program coordinator) and conducted a cross-sectional survey of patients nonadherent to annual follow-up to elicit quantitative and qualitative feedback.

Results: Of the 319 patients who completed baseline lung screening with normal results, 189 (59%) were adherent to annual follow-up recommendations and 130 (41%) were nonadherent. Patient adherence varied over time: 21.7% adherence (10 of 46) before hiring a program coordinator and 65.6% adherence (179 of 273) after the program coordinator's hire date. Patients reported the following reasons for nonadherence to annual lung screening: lack of transportation, financial cost, lack of communication by physicians, and lack of current symptoms.

Conclusions: Adherence to annual lung screening after normal baseline studies increased significantly over time. Hiring a full-time program coordinator was likely associated with this increased in adherence.

Keywords: Adherence; low-dose CT; lung cancer; screening.

Published by Elsevier Inc.

Figures

Fig 1.

Study cohort. Flowchart demonstrating number of patients meeting inclusion and exclusion criteria for study participation. Primary analysis inclusion criteria: Lung-RADS 1 or 2 LDCT lung screening study between January 1, 2014, and September 30, 2016. Primary analysis exclusion criteria: nonbaseline study, death, follow-up recommendation less than 12 months, cancer diagnosis. *LDCT = low-dose CT; Lung-RADS = Lung CT Screening Reporting & Data System.

Fig 2.

Adherence to annual lung screening follow-up over time. P-chart demonstrating quarterly adherence among those eligible for follow-up screening over time. Dotted black vertical line represents when the program coordinator was hired. Grey horizontal lines represent mean adherence values (before and after hiring of the program coordinator). Red lines represent upper control limit (UCL) and lower control limit (LCL). Control limits vary by quarter and represent 3 SDs from the central line (based on standard statistical process control methodology). As the central line (mean adherence) is a proportion, the LCL must be greater than or equal to zero. Number of eligible patients in each quarter is presented below the p-chart.