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A4414 - Improvement in Compliance with Lung Cancer Screening Implementation in an Urban Teaching Hospital Internal Medicine Clinic, Following Institution of an Education Initiative
Author Block: C. Olazagasti1, A. Rothman2, D. Sampat3, D. Chow4, D. Steiger5; 1Beth Israel Deaconess Medical Center, Boston, MA, United States, 2Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai Beth Israel, New York, NY, United States, 3Mount Sinai Beth Israel, New York, NY, United States, 4Mount Sinai Beth Israel, new york, NY, United States, 5Pulmonary/Critical Care, Mount Sinai Beth Israel, New York, NY, United States.
Rationale: Lung cancer is the leading cause of cancer-related deaths worldwide. The U.S. Preventative Services Task Force (USPSTF) recommends annual low-dose CT chest (LDCT) for lung cancer screening in adults who meet the appropriate criteria. Even with these recommendations, screening rates in these patients remain low. We, therefore, created a study to assess compliance in an outpatient clinic staffed by attendings and resident physicians and assessed the barriers to obtaining LDCT. We hypothesized that by providing an educational program, overall compliance would increase.
Methods: In the first half of the study, 678 patient visits were reviewed over three months in 2016. The participating medical residents and attendings worked in an Internal Medicine clinic at an urban teaching hospital. 35 physicians completed a questionnaire on their attitudes to LDCT screening and their reasons for not screening high-risk patients. With this information, we created a lung cancer screening education program, which consisted of lectures provided to house staff detailing lung cancer epidemiology, screening criteria, and the data behind these screening techniques. Following the lectures, we reviewed 955 consecutive patient visits over three months in early 2017.
Results: Out of the initial 678 patient visits reviewed, 115 patients met USPSTF criteria, of whom only 30/115 (26%) underwent LDCT. 132 patients met NCCN criteria, of whom only 35/132 (26%) received LDCT. Only 36% of the 35 physician respondents stated they routinely order LDCT scans. The most common reasons for not ordering LDCT scans in patients meeting USPSTF, orNCCN criteria included: not knowing the screening criteria (22%), failure to determine if patients qualified for LDCT (13%), patient refusal of LDCT (8%), uncertainties about following up the results (3%), and concern regarding insurance approval (2%). Following the education program, 208 patients of the reviewed 955 patient visits met USPSTF criteria, and 162/208(78%) of these patients underwent LDCT. 237 patients met NCCN criteria, of whom 166/237 (70%) received LDCT. The remaining noncompliance was largely felt to be related to insufficient time for shared decision-making during visits.
Conclusions: We confirmed there was a suboptimal adherence to established LDCT lung cancer screening guidelines, mainly due to unfamiliarity with the screening criteria. By providing a series of educational lectures, compliance improved significantly. We conclude that educating medical residents and attendings about lung cancer screening guidelines can effectively increase LDCT screening for the appropriate patients, and therefore benefit patients at high risk for developing lung cancer.