View Abstract

A5978 - A Qualitative Study of Clinician Views of Lung Cancer Screening: The Role of Uncertainty
Author Block: A. C. Melzer1, S. Golden2, L. Miranda2, S. Ono3, C. G. Slatore4; 1Pulmonary and Critical Care, Minneapolis VA Healthcare System, Minneapolis, MN, United States, 2Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, United States, 3Center to Improve Veteran Involvement in Care, Portland VA Health Care System, Portland, OR, United States, 4Pulmonary and Critical Care, Portland VA Health Care System, Portland, OR, United States.
Rationale: Since the National Lung Screening Trial demonstrated a mortality benefit with low-dose CT screening for lung cancer, lung cancer screening (LCS) has been widely implemented. New programs may face barriers to implementation, which may include lack of clinician knowledge, or beliefs that the intervention is not beneficial. Our objective was to evaluate diverse clinician perspectives on the evidence behind and the process of performing LCS.
Methods: We conducted a qualitative study of clinicians participating in LCS. Clinicians were drawn from multiple specialties and practice settings. All participants practiced at sites with formal lung cancer screening programs. We performed semi-structured phone interviews, with interview probes designed to elicit opinions of LCS, perceived evidence gaps, and recommendations for improvements to program structure. Transcribed interviews were iteratively reviewed and coded using directed content analysis.
Results: Participants (n=27) included LCS coordinators, pulmonologists, primary care providers (PCPs) and radiologists. Most clinicians expressed confidence that the evidence in favor of LCS was adequate to support adoption of this clinical intervention. Specific knowledge of the magnitude of the risks and benefits of LCS varied by role, and was highest among coordinators and pulmonologists. Most primary care providers were generally familiar with guidelines endorsing LCS, and less familiar with the results of the NLST or the necessary criteria to qualify for screening, such as age cutoffs and tobacco history. Some were unclear whether scans should be performed annually versus once, or for longer than 3 cycles. All clinicians expressed uncertainty about many aspects of LCS, including: appropriate risk population to be screened, optimal duration of screening, ideal follow-up intervals, and indications to stop screening such as worsening comorbidities or declining cancer risk. Clinicians supported programmatic elements geared to make LCS more equitable for patients and efficient for providers, such as clinical reminders, tailored risk assessments, patient tracking systems that are integrated into the electronic health record, and straightforward clinical guidelines. All clinicians supported the necessity of a dedicated coordinator to assist with patient education and tracking, as well as to ensure program quality as recommendations continue to shift.
Conclusions: Clinicians participating in LCS believe that the evidence is adequate to support this intervention, but express both knowledge gaps regarding current screening recommendations, and the desire for more research to allow tailoring conversations with patients. Formal LCS programs may be best able to provide updates to clinical practices as new research become available.