Pack-Year Cigarette Smoking History for Determination of Lung Cancer Screening Eligibility. Comparison of the Electronic Medical Record versus a Shared Decision-making Conversation

Abstract

Many individuals referred for lung cancer screening may be ineligible. Overreliance on the EMR for identification of individuals at risk may lead to missed opportunities for appropriate lung cancer screening.

Capture of tobacco use among population‐based registries: Findings from 10 National Program of Cancer Registries states

“…In addition, it is known that EHRs underestimate pack‐years or have missing pack‐year data, and in the context of a survey, multiple questions are required for an accurate assessment . Adding pack‐years to CER tobacco use variables for registrar abstraction may require further data validation and standardization . Finally, electronic cigarette (e‐cigarette) use and nicotine gum use were not included in tobacco use variable data abstraction, although states were asked to note the use of these items in a text field for future reference.…”

“…38,39 Pack-years were not included in the CER study because the level of detail needed to access this information accurately is not routinely and consistently available in the medical records from which abstractors collected the CER study data. In addition, it is known that EHRs underestimate pack-years or have missing pack-year data, 40,41 and in the context of a survey, multiple questions are required for an accurate assessment. 42 Adding pack-years to CER tobacco use variables for registrar abstraction may require further data validation and standardization.…”

“…42 Adding pack-years to CER tobacco use variables for registrar abstraction may require further data validation and standardization. 40 Finally, electronic cigarette (e-cigarette) use and nicotine gum use were not included in tobacco use variable data abstraction, although states were asked to note the use of these items in a text field for future reference. Although e-cigarette use has been increasing in prevalence, 43 the use of e-cigarettes presents a different toxicity profile than cigarette use 44 and may have further complicated the study's aim of collecting tobacco use data.…”

Cancer screening in the United States, 2019: A review of current American Cancer Society guidelines and current issues in cancer screening

“…Identifying adults who are eligible for screening and conducting shared decision making add an additional burden on primary care providers, who must be given the tools and the incentives to fulfill their important role. Electronic health records should enable the identification of adults who meet tobacco exposure and other eligibility requirements, but early experience has demonstrated that they perform poorly, resulting in an additional burden when health care professionals need to interview patients to assess pack‐year history . Furthermore, as smoking has become increasingly concentrated in lower socioeconomic populations, greater barriers to access are experienced by adults who comprise the target population for lung cancer screening compared with other screening tests.…”

“…Electronic health records should enable the identification of adults who meet tobacco exposure and other eligibility requirements, but early experience has demonstrated that they perform poorly, resulting in an additional burden when health care professionals need to interview patients to assess pack-year history. 141,142 Furthermore, as smoking has become increasingly concentrated in lower socioeconomic populations, 143 greater barriers to access are experienced by adults who comprise the target population for lung cancer screening compared with other screening tests. Jemal and Fedewa reported that over 50% of current and former smokers who met USPSTF criteria in 2015 were uninsured or Medicaid-insured.…”