An Analysis of Lung Cancer Screening Beliefs and Practice Patterns for Community Providers Compared to Academic Providers

Abstract

Despite guidelines recommending annual low-dose computed tomography (LDCT) screening for lung cancer, uptake remains low due to the perceived complexity of initiating and maintaining a clinical program—problems that likely magnify in underserved populations. We conducted a survey of community providers at Federally Qualified Health Centers (FQHCs) in Santa Clara County, California, to evaluate provider-related factors that affect adherence. We then compared these findings to academic providers’ (APs) LDCT screening knowledge, behaviors, and attitudes at an academic referral center in the same county. The 4 FQHCs enrolled care for 80 000 patients largely of minority descent and insured by Medi-Cal. Of the 75 FQHC providers (FQHCPs), 36 (48%) completed the survey. Of the 36 providers, 8 (22%) knew screening criteria. Fifteen (42%) FQHCPs discussed LDCT screening with patients. Compared to 36 APs, FQHCPs were more concerned about harms, false positives, discussion time, patient apathy, insurance coverage, and a lack of expertise for screening and follow-up. Yet, more FQHCPs thought screening was effective (27 [75%] of 36) compared to APs (P = .0003). In conclusion, provider knowledge gaps are greater and barriers are different for community clinics caring for underserved populations compared to their academic counterparts, but practical and scalable solutions exist to enhance adoption.

Individual decision making about lung cancer screening: A conjoint analysis of perspectives among a high‐risk national sample

“…Similar to other cancer screening contexts, we found that clinician recommendations played a substantial role in patient ratings of anticipated screening [eg, ], highlighting the importance of clinician‐patient communication and training with regard to LCS and shared decision making. However, some previous studies of primary care clinicians have demonstrated suboptimal knowledge, attitudes, and practices with regarding to LCS. For example, only 22% to 31% of primary care providers knew the correct LCS eligibility criteria, which led to inappropriate LCS referrals.…”

“…However, some previous studies of primary care clinicians have demonstrated suboptimal knowledge, attitudes, and practices with regarding to LCS. For example, only 22% to 31% of primary care providers knew the correct LCS eligibility criteria, which led to inappropriate LCS referrals. Thus, our research highlights the need for up‐to‐date knowledge about LCS among primary care providers.…”

A narrative review of lung cancer screening in underserved populations

“…Importantly, previous studies have demonstrated that physicians who are aware of the guidelines are more likely to initiate discussions of lung cancer screening with their patients (45) and order LDCT screening tests (45,46). However, since the USPSTF's endorsement of LDCT screening, multiple institutional reports have shown that primary care physicians in underserved areas have a relatively limited understanding of the guidelines and their supporting evidence (47)(48)(49)(50)(51)(52). While the exact reasons for this uncertainty are not well known, discordance between NCCN and USPSTF indications for screening, lack of familiarity of the survival benefit associated with LDCT screening, and concerns regarding false positive rates and excess harms to the patient may all play a role (49)(50)(51)53).…”

“…However, since the USPSTF's endorsement of LDCT screening, multiple institutional reports have shown that primary care physicians in underserved areas have a relatively limited understanding of the guidelines and their supporting evidence (47)(48)(49)(50)(51)(52). While the exact reasons for this uncertainty are not well known, discordance between NCCN and USPSTF indications for screening, lack of familiarity of the survival benefit associated with LDCT screening, and concerns regarding false positive rates and excess harms to the patient may all play a role (49)(50)(51)53). Efforts to familiarize healthcare providers with these topics through the distribution of educational materials and group based learning methods have been shown to be feasible at individual centers (54).…”

Lung cancer screening practices among primary care providers in Northern Texas

“…It was estimated that 6.8 million smokers were eligible for LDCT screening, while only 3.9% of eligible Americans reported receiving screening for lung cancer with LDCT in 2015 [8]. Reasons for low uptake of screening may include gaps in patients' knowledge about the LDCT screening, lack of access to health care [9][10][11], and physicians' knowledge and perception regarding the screening recommendation and patient cost [11][12][13][14][15][16][17][18]. For most adult patients in the U.S., primary care providers (PCPs) play a critical role in offering preventive healthcare and screening; therefore, an understanding of PCPs' utilization and perceptions on lung cancer screening guidelines is necessary to improve appropriate assessment and referrals for specialty care services, as well as overall implementation of the screening procedure.…”