Lung Cancer Screening Knowledge and Perceived Barriers Among Physicians in the United States

Kota, Karthik; Ji, Stephanie; Bover-Manderski, Michelle T.; Delnevo, Cristine D.; Steinberg, Michael B.

doi:10.1016/j.jtocrr.2022.100331

Cited by 7 publications

(6 citation statements)

References 24 publications

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“…Consistent with the extant literature (Kota et al, 2022 ), providers identified several patient-level barriers to LDCT including cost, insurance coverage, and lack of patient awareness. Additionally, the literature documents racial/ethnic differences in screening completion rates following referral (Haddad et al, 2020 ; Lake et al, 2020 ).…”

Section: Discussionsupporting

confidence: 56%

“…An interview guide was developed based on the literature describing lung cancer screening in clinical practice settings (Kota et al, 2022 ; Lin et al, 2022 ; Rodríguez- Rabassa et al, 2020). The guide covered awareness and knowledge of lung cancer screening, practice behaviors, patient barriers to screening, and recommendations for increasing screening.…”

Section: Methodsmentioning

confidence: 99%

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Examination of provider knowledge, attitudes, and behaviors associated with lung cancer screening among Black men receiving care at a federally qualified health center

Matthews,

Inwanna,

Oyaluade

et al. 2023

Qual Res Med Healthc

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The study's goal was to look at providers' knowledge, attitudes, and behaviors regarding lung cancer screening among Black male smokers served by a federally qualified healthcare center. Participants in the study were interviewed in depth. Participants completed a short (5-10 minute) survey that assessed demographics, training, and attitudes toward lung cancer screening. For quantitative data, descriptive statistics were used, and for qualitative data, deductive thematic analysis was used. This study included ten healthcare professionals, the majority of whom identified as Black (80%) and were trained as advanced practice providers (60%). The majority of providers (90%) have heard of LDCT lung cancer screening; however, participants reported only being “somewhat” familiar with the LDCT eligibility criteria (70%). Despite generally positive attitudes toward LDCT, patient referral rates for screening were low. Barriers included a lack of provider knowledge about screening eligibility, a lack of use of shared decision-making tools, and patient concerns about screening risks. The reasons for the low referral rates varied, but they included a preference to refer patients for smoking cessation rather than screening, low screening completion and follow-up rates among referred patients, and a lower likelihood that Black smokers will meet pack-year requirements for screening. Additionally, providers discussed patient-level factors such as a lack of information, mistrust, and transportation. The study findings add to the body of knowledge about lung cancer knowledge and screening practices among providers in FQHC settings. This data can be used to create health promotion interventions aimed at smoking cessation and lung cancer screening in Black males and other high-risk smokers.

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Section: Discussionsupporting

confidence: 56%

Section: Methodsmentioning

confidence: 99%

Examination of provider knowledge, attitudes, and behaviors associated with lung cancer screening among Black men receiving care at a federally qualified health center

Matthews,

Inwanna,

Oyaluade

et al. 2023

Qual Res Med Healthc

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“…The UTD-LCS prevalence was higher among the 39 Medicaid expansion states than among 12 nonexpansion states (8 southern, 3 midwestern, and 1 western) (eTable in Supplement 1) among adults aged 50 to 64 years (APR, 2.68; 95% CI, 1.30-5.53) and among adults aged 50 to 64 years (APR, 2.92; 95% CI, 1.04-8. 19) with lower income (Table 3). Compared with lowerlevel LCS capacity states, UTD-LCS prevalence was higher in states with high-level (APR, 1.93; 95% CI, 1.36-2.75) and medium-level (APR, 1.44; 95% CI, 1.00-2.07) capacity (Table 3 and eFigure 2 and the eTable in Supplement 1).…”

Section: Resultsmentioning

confidence: 99%

Lung Cancer Screening in the US, 2022

Bandi,

Star,

Ashad-Bishop

et al. 2024

JAMA Intern Med

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ImportanceThe US Preventive Services Task Force (USPSTF) recommends annual lung cancer screening (LCS) with low-dose computed tomography in high-risk individuals (age 50-80 years, ≥20 pack-years currently smoking or formerly smoked, and quit &lt;15 years ago) for early detection of LC. However, representative state-level LCS data are unavailable nationwide.ObjectiveTo estimate the contemporary prevalence of up-to-date (UTD) LCS in the US nationwide and across the 50 states and the District of Columbia.Design, Setting, and ParticipantsThis cross-sectional study used data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) population-based, nationwide, state-representative survey for respondents aged 50 to 79 years who were eligible for LCS according to the 2021 USPSTF eligibility criteria. Data analysis was performed from October 1, 2023, to March 20, 2024.Main Outcomes and MeasuresThe main outcome was self-reported UTD-LCS (defined as past-year) prevalence according to the 2021 USPSTF eligibility criteria in respondents aged 50 to 79 years. Adjusted prevalence ratios (APRs) and 95% CIs compared differences.ResultsAmong 25 958 sample respondents eligible for LCS (median [IQR] age, 62 [11] years), 61.5% reported currently smoking, 54.4% were male, 64.4% were aged 60 years or older, and 53.0% had a high school education or less. The UTD-LCS prevalence was 18.1% overall, but varied across states (range, 9.7%-31.0%), with relatively lower levels in southern states characterized by high LC mortality burden. The UTD-LCS prevalence increased with age (50-54 years: 6.7%; 70-79 years: 27.1%) and number of comorbidities (≥3: 24.6%; none: 8.7%). A total of 3.7% of those without insurance and 5.1% of those without a usual source of care were UTD with LCS, but state-level Medicaid expansions (APR, 2.68; 95% CI, 1.30-5.53) and higher screening capacity levels (high vs low: APR, 1.93; 95% CI, 1.36-2.75) were associated with higher UTD-LCS prevalence.Conclusions and RelevanceThis study of data from the 2022 BRFSS found that the overall prevalence of UTD-LCS was low. Disparities were largest according to health care access and geographically across US states, with low prevalence in southern states with high LC burden. The findings suggest that state-based initiatives to expand access to health care and screening facilities may be associated with improved LCS rates and reduced disparities.

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“…Supporting these concerns, recent studies have demonstrated that physicians' knowledge and practices related to LCS remain suboptimal. [27][28][29] In a survey of almost 600 primary care physicians, .40% of respondents did not know that the screening interval was annual, and fewer than half knew the ages for starting and stopping screening. 27 Because of clinicians' critical role in engaging patients in LCS and ordering LDCT, concerted efforts to improve awareness of screening guidelines and identify barriers to order placement, particularly after initial LDCT, are crucial.…”

Section: Discussionmentioning

confidence: 99%

“…[27][28][29] In a survey of almost 600 primary care physicians, .40% of respondents did not know that the screening interval was annual, and fewer than half knew the ages for starting and stopping screening. 27 Because of clinicians' critical role in engaging patients in LCS and ordering LDCT, concerted efforts to improve awareness of screening guidelines and identify barriers to order placement, particularly after initial LDCT, are crucial. Future initiatives incorporating navigators who work directly with both patients and clinical teams as well as EHR interventions to simplify LCS ordering and follow-up may be advantageous.…”

Section: Discussionmentioning

confidence: 99%

Effect of Patient Navigation on Completion of Lung Cancer Screening in Vulnerable Populations

Bhalla,

Natchimuthu,

Lee

et al. 2024

Journal of the National Comprehensive Cancer Network

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Background: Although low-dose, CT–based lung cancer screening (LCS) can decrease lung cancer mortality in high-risk individuals, the process may be complex and pose challenges to patients, particularly those from minority underinsured and uninsured populations. We conducted a randomized controlled trial of telephone-based navigation for LCS within an integrated, urban, safety-net health care system. Patients and Methods: Patients eligible for LCS were randomized (1:1) to usual care with or without navigation at Parkland Health in Dallas, Texas. The primary endpoint was completion of the first 3 consecutive steps in a patient’s LCS process. We explored differences in completion of LCS steps between navigation and usual care groups, controlling for patient characteristics using the chi-square test. Results: Patients (N=447) were randomized to either navigation (n=225) or usual care (n=222). Mean patient age was 62 years, 46% were female, and 69% were racial/ethnic minorities. There was no difference in completion of the first 3 steps of the LCS algorithm between arms (12% vs 9%, respectively; P=.30). For ordered LCS steps, completion rates were higher among patients who received navigation (86% vs 79%; P=.03). The primary reason for step noncompletion was lack of order placement. Conclusions: In this study, lack of order placement was a key reason for incomplete LCS steps. When orders were placed, patients who received navigation had higher rates of completion. Clinical team education and enhanced electronic health record processes to simplify order placement, coupled with patient navigation, may improve LCS in safety-net health care systems.

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Lung Cancer Screening Knowledge and Perceived Barriers Among Physicians in the United States

Cited by 7 publications

References 24 publications

Examination of provider knowledge, attitudes, and behaviors associated with lung cancer screening among Black men receiving care at a federally qualified health center

Examination of provider knowledge, attitudes, and behaviors associated with lung cancer screening among Black men receiving care at a federally qualified health center

Lung Cancer Screening in the US, 2022

Effect of Patient Navigation on Completion of Lung Cancer Screening in Vulnerable Populations

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