Attitudes about Low-Dose Computed Tomography Screening for Lung Cancer: A Survey of American Thoracic Society Clinicians

Simmons, James A.; Gould, Michael K.; Woloshin, Steven; Schwartz, Lisa M.; Wiener, Renda Soylemez

doi:10.1164/rccm.201409-1747le

Cited by 12 publications

(8 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Prior work examining pulmonologists’ attitudes toward lung cancer screening include a national survey to pulmonologists in Veterans Health Administration clinics from July 2013 to February 2014 and an international sample of ATS clinicians from March to April of 2014 [13, 18]. Among pulmonologists in Veterans clinics, the most commonly cited barriers to screening were poor infrastructure and lack of clinical personnel.…”

Section: Discussionmentioning

confidence: 99%

“…Among pulmonologists in Veterans clinics, the most commonly cited barriers to screening were poor infrastructure and lack of clinical personnel. Respondents of the ATS survey who said they would screen an NLST-eligible patient reported the following barriers to screening: false positives (52%), over-diagnosis (44%), and high cost to the health care system (33%) [13].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Opinions and Practices of Lung Cancer Screening by Physician Specialty

Henderson¹,

Marsh²,

Benefield³

et al. 2019

North Carolina Medical Journal

View full text Add to dashboard Cite

BACKGROUND In response to the National Lung Screening Trial, numerous professional organizations published guidelines recommending annual lung cancer screening with low-dose computed tomography (LDCT) for high-risk patients. Prior studies found that physician attitudes and knowledge about lung cancer screening directly impacts the number of screening exams ordered. METHODS In 2015, we surveyed 34 pulmonologists and 186 primary care providers (PCPs) to evaluate opinions and practices of lung cancer screening in a large academic medical center. We compared PCP and pulmonologist responses using t-tests and ᵪ2 tests. RESULTS The overall survey response rate was 40% (39% for PCPs and 50% for pulmonologists). Pulmonologists were more likely than PCPs to report lung cancer screening as beneficial for patients (88.2% versus 37.7%, P < .0001) and as being cost-effective (47.1% versus 14.3%, P = .02). More pulmonologists (76%) reported ordering a LDCT for screening in the past 12 months compared to PCPs (41%, P = .012). Pulmonologists and PCPs reported similar barriers to referring patients for lung cancer screening, including patient costs (82.4% versus 77.8%), potential for emotional harm (58.8% versus 58.3%), high false positive rate (47.1% versus 69.4%), and likelihood for medical complications (47.1% versus 59.7%). LIMITATIONS Our results are generalizable to academic medical centers and responses may be susceptible to recall bias, non-response bias, and social desirability bias. CONCLUSION We found significant differences in opinions and practices between PCPs and pulmonologists regarding lung cancer screening referrals and perceived benefits. As lung cancer screening continues to emerge in clinical practice, it is important to understand these differences across provider specialty to ensure screening is implemented and offered to patients appropriately.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Opinions and Practices of Lung Cancer Screening by Physician Specialty

Henderson¹,

Marsh²,

Benefield³

et al. 2019

North Carolina Medical Journal

View full text Add to dashboard Cite

show abstract

“…Published studies demonstrate that insurance coverage, 14 time constraints, 31 difficulty managing associated screening findings, and false positives 8 , 32 , 33 are all provider-level barriers to screening uptake. Some of these perceived barriers have been recently published as obstacles for clinical lung cancer screening programs in underserved populations.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

View full text Add to dashboard Cite

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.

show abstract

“…Although the results of the NLST are encouraging, if implemented poorly, lung cancer screening may not only fail to realize the mortality benefit observed in the NLST but may also result in patient harm (16). Hospitals around the country, both VA and non-VA, are struggling to determine how best to implement safe and effective lung cancer screening programs (26).…”

Section: Discussionmentioning

confidence: 99%

Readiness for Implementation of Lung Cancer Screening: A National Survey of VA Pulmonologists

et al. 2016

Self Cite

View full text Add to dashboard Cite

Rationale: To mitigate the potential harms of screening, professional societies recommend that lung cancer screening be conducted in multidisciplinary programs with the capacity to provide comprehensive care, from screening through pulmonary nodule evaluation to treatment of screen-detected cancers. The degree to which this standard can be met at the national level is unknown.Objectives: To assess the readiness of clinical facilities in a national healthcare system for implementation of comprehensive lung cancer screening programs, as compared with the ideal described in policy recommendations.Methods: This was a cross-sectional, self-administered survey of staff pulmonologists in pulmonary outpatient clinics in Veterans Health Administration facilities. Measurements and Main Results:The facility-level response rate was 84.1% (106 of 126 facilities with pulmonary clinics); 88.7% of facilities showed favorable provider perceptions of the evidence for lung cancer screening, and 73.6% of facilities had a favorable provider-perceived local context for screening implementation. All elements of the policyrecommended infrastructure for comprehensive screening programs were present in 36 of 106 facilities (34.0%); the most common deficiencies were the lack of on-site positron emission tomography scanners or radiation oncology services. Overall, 26.5% of Veterans Health Administration facilities were ideally prepared for lung cancer screening implementation (44.1% if the policy recommendations for on-site positron emission tomography scanners and radiation oncology services were waived).Conclusions: Many facilities may be less than ideally positioned for the implementation of comprehensive lung cancer screening programs. To ensure safe, effective screening, hospitals may need to invest resources or coordinate care with facilities that can offer comprehensive care for screening through downstream evaluation and treatment of screen-detected cancers.

show abstract

Attitudes about Low-Dose Computed Tomography Screening for Lung Cancer: A Survey of American Thoracic Society Clinicians

Cited by 12 publications

References 8 publications

Opinions and Practices of Lung Cancer Screening by Physician Specialty

Opinions and Practices of Lung Cancer Screening by Physician Specialty

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

Readiness for Implementation of Lung Cancer Screening: A National Survey of VA Pulmonologists

Contact Info

Product

Resources

About