Low Provider Knowledge Is Associated With Less Evidence-Based Lung Cancer Screening

Abstract

Background: Despite widespread recommendation and supportive policies, screening with low-dose CT (LDCT) is incompletely implemented in the US healthcare system. Low provider knowledge of the lung cancer screening (LCS) guidelines represents a potential barrier to implementation. Therefore, we tested the hypothesis that low provider knowledge of guidelines is associated with less provider-reported screening with LDCT. Patients and Methods: A cross-sectional survey was performed in a large academic medical center and affiliated Veterans Health Administration in the Mid-South United States that comprises hospital and community-based practices. Participants included general medicine providers and specialists who treat patients aged >50 years. The primary exposure was LCS guideline knowledge (US Preventive Services Task Force/Centers for Medicare & Medicaid Services). High knowledge was defined as identifying 3 major screening eligibility criteria (55 years as initial age of screening eligibility, smoking status as current or former smoker, and smoking history of ≥30 pack-years), and low knowledge was defined as not identifying these 3 criteria. The primary outcome was self-reported LDCT order/referral within the past year, and the secondary outcome was screening chest radiograph. Multivariable logistic regression evaluated the adjusted odds ratio (aOR) of screening by knowledge. Results: Of 625 providers recruited, 407 (65%) responded, and 378 (60.5%) were analyzed. Overall, 233 providers (62%) demonstrated low LCS knowledge, and 224 (59%) reported ordering/referring for LDCT. The aOR of ordering/referring LDCT was less among providers with low knowledge (0.41; 95% CI, 0.24–0.71) than among those with high knowledge. More providers with low knowledge reported ordering screening chest radiographs (aOR, 2.7; 95% CI, 1.4–5.0) within the past year. Conclusions: Referring provider knowledge of LCS guidelines is low and directly proportional to the ordering rate for LDCT in an at-risk US population. Strategies to advance evidence-based LCS should incorporate provider education and system-level interventions to address gaps in provider knowledge.

National lung cancer screening utilization trends in the Veterans Health Administration.

“…In the VHA's demonstration project, only 57.7% of eligible Veterans agreed to be screened and reasons for declining screening are unknown (9). At the provider level, awareness of lung cancer screening and knowledge of the guidelines is also critical (14). Studies of VHA providers found that knowledge of the USPSTF guidelines and Centers for Medicare & Medicaid Services (CMS) coverage criteria is low (14,15), and providers who lack knowledge are less likely to perform screening (14).…”

Evidence-based smoking cessation treatment: a comparison by healthcare system

“…Details of the questionnaire have been published elsewhere and are summarized here [ 22 ]. Between February and May 2017, we surveyed 625 healthcare providers across four specialties (General Internal Medicine, Pulmonology, Hematology/Oncology, and Gynecology) that are primarily responsible for preventive services (General Internal Medicine, Gynecology), care for patients with smoking-related lung disease (Pulmonology) or patients with a history of cancer (Hematology/Oncology) at two institutions (AHC and VHA) and included hospital-based and community-based practices.…”

Lung Screening Benefits and Challenges: A Review of The Data and Outline for Implementation

“…61 Lack of CLTS knowledge may prevent PCPs from engaging in shared decision making (SDM) conversations with their patients. 62 A recent study reported that PCPs who are less familiar with the qualifying CTLS criteria had 2.7 times higher odds of ordering CXR than CTLS. 62 The Centers for Medicare & Medicaid Services (CMS) requires the use of a formal decision aid as part of CTLS SDM.…”

“…62 A recent study reported that PCPs who are less familiar with the qualifying CTLS criteria had 2.7 times higher odds of ordering CXR than CTLS. 62 The Centers for Medicare & Medicaid Services (CMS) requires the use of a formal decision aid as part of CTLS SDM. 40 An accurate decision aid that is understandable to the general public is critical, and we provide an updated decision aid for use in clinics (Fig.…”