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A5977 - Success Factors and Barriers in Lung Cancer Screening Program Implementation in the VA: Results of a Qualitative Study
Author Block: A. E. Fabbrini1, S. E. Lillie2, S. S. Fu2, C. H. Wendt1, A. C. Melzer1; 1Pulmonary Section, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States, 2Center for Chronic Disease and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States.
Rationale: Lung cancer screening (LCS) is a recent clinical innovation that, if implemented correctly, decreases mortality from lung cancer through early detection. This process is complex, which may create barriers to implementation of LCS. The structure and size of LCS programs varies depending on the size and needs of each site. We sought to formally assess the needs and perceived barriers of programs that are considering formal program implementation, informed by the experiences of sites that are performing LCS on a wider scale.
Methods: We identified five VA sites currently performing lung cancer screening and five sites that were considering LCS program implementation. We identified six elements from the Consolidated Framework for Implementation Research hypothesized to be key for LCS implementation: implementation climate, relative priority, leadership engagement, knowledge and beliefs, formally appointed leaders, and available resources. These elements were developed into two interview guides administered by phone to one contact at each location.
Results: Contacts included: three LCS coordinators, two LCS physicians, one respiratory therapist, two nurses and two midlevel providers, the latter two with experience tracking incidental pulmonary nodules. Several themes emerged from the interviews: for all sites interviewed, the most important elements identified for starting and maintaining a program were leadership support, formally identified program staff, and access to medical informaticists. For existing programs, three sites employed a coordinator to assist with the implementation and ongoing administration of an LCS program. A number of sites felt knowledge of LCS among primary care and leadership was low, with relatively low program implementation prioritization. Most sites felt that primary care would be open to providing LCS as long as it would not add significantly to workload. Among sites considering undertaking LCS, several additional barriers were identified, these included: i) variable and contract staffing in radiology resulted in lack of standardized impressions to guide follow up recommendations, ii) smaller sites had limited subspecialty staff, such as pulmonologists, to provide oversight and expertise in the management of small nodules, and iii) concerns that increasing the number of moderate risk nodules would tax limited consultative resources.
Conclusion: Defined program leadership, strong institutional support (including dedicated FTE), and access to informatics support were perceived as success factors. Perceived barriers to formal screening programs included lack of standardized radiology reports, limited specialty care resources, and low institutional knowledge and priority. Access to VA-specific program tools may expedite the spread of LCS.