Volume 7, Issue 1, March 2019, Page: 1-8
Examining Lung Cancer Screening Behaviors in the Primary Care Setting: A Mixed Methods Approach
Alvie Ahsan, Jacobs School of Medicine and Biomedical Sciences, State University at New York at Buffalo, Buffalo, USA
Eva Zimmerman, Department of Cancer Prevention & Control, Roswell Park Comprehensive Cancer Center, Buffalo, USA
Elisa Marie Rodriguez, Department of Cancer Prevention & Control, Roswell Park Comprehensive Cancer Center, Buffalo, USA
Christy Widman, Department of Cancer Prevention & Control, Roswell Park Comprehensive Cancer Center, Buffalo, USA
Deborah Oates Erwin, Department of Cancer Prevention & Control, Roswell Park Comprehensive Cancer Center, Buffalo, USA
Frances Georgette Saad-Harfouche, Department of Cancer Prevention & Control, Roswell Park Comprehensive Cancer Center, Buffalo, USA
Martin Christopher Mahoney, Department of Cancer Prevention & Control, Roswell Park Comprehensive Cancer Center, Buffalo, USA; Department of Internal Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, USA
Received: Jan. 15, 2019;       Accepted: Feb. 16, 2019;       Published: Mar. 11, 2019
DOI: 10.11648/j.jctr.20190701.11      View  758      Downloads  119
While the National Lung Screening Trials (NLST) demonstrated the efficacy of low dose chest computed tomography (LDCT) for lung cancer early detection, utilization of LDCT remains suboptimal. The purpose of this formative study was to understand attitudes and beliefs among primary care clinicians regarding LDCT lung cancer screening as well as to assess gaps in knowledge to identify opportunities for reinforcing personalized lung cancer screening that is accessible and evidence-based. A 20-item closed and open-ended interview was conducted with a targeted group of primary care clinicians (38 respondents; 33 physicians and 5 NPs/PAs). Quantitative data were analyzed using descriptive statistics while qualitative data was analyzed thematically. Although 50.0% of clinicians characterized LDCT as “very effective”, only 47.4% of clinicians reported that they frequently or often recommend LDCT as a lung cancer screening tool. Respondents were generally unconcerned with the high rate of false positive test results. The majority of clinicians were referring patients for LDCT based on smoking history, however other factors were also considered (e.g., health status, sex, family history, past medical history, and occupational exposures.) The majority of respondents were knowledgeable about the use of LDCT as a lung screening tool but were unsure about its effectiveness for lung cancer early detection. Some clinicians are recommending patients for LDCT based on factors which are inconsistent with evidence-based guidelines.
Lung Cancer Screening, Early Detection, Clinician Education, Primary Care, Provider Perception
To cite this article
Alvie Ahsan, Eva Zimmerman, Elisa Marie Rodriguez, Christy Widman, Deborah Oates Erwin, Frances Georgette Saad-Harfouche, Martin Christopher Mahoney, Examining Lung Cancer Screening Behaviors in the Primary Care Setting: A Mixed Methods Approach, Journal of Cancer Treatment and Research. Vol. 7, No. 1, 2019, pp. 1-8. doi: 10.11648/j.jctr.20190701.11
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Centers for Disease Control and Prevention (2017a). United States cancer statistics: 1999-2014 incidence and mortality web-based report. 2017; www.cdc.gov/cancer/uscs. Accessed February 14, 2019.
Centers for Disease Control and Prevention (2017b). Smoking and cancer. 2017; https://www.cdc.gov/tobacco/campaign/tips/diseases/cancer.html#how-related. Accessed February 14, 2019.
Noone AM, Howlader N, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2015, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2015/, based on November 2017 SEER data submission, posted to the SEER web site, April 2018; https://seer.cancer.gov/statfacts/html/lungb.html. Accessed February 14, 2019.
Moyer VA. Screening for lung cancer: US Preventive Services Task Force recommendation statement. Annals of internal medicine. 2014; 160(5):330-338.
National Lung Screening Trial research Team (2011). Reduced lung-cancer mortality with low-dose computed tomographic screening. New England Journal of Medicine. 2011; 365(5):395-409.
Hoffman RM, Sussman AL, Getrich CM, et al. Peer Reviewed: Attitudes and Beliefs of Primary Care Providers in New Mexico About Lung Cancer Screening Using Low-Dose Computed Tomography. Preventing chronic disease. 2015; 12.
Iaccarino JM, Clark J, Bolton R, et al. A national survey of pulmonologists’ views on low-dose computed tomography screening for lung cancer. Annals of the American Thoracic Society. 2015; 12(11):1667-1675.
Lewis JA, Petty WJ, Tooze JA, et al. Low-dose CT lung cancer screening practices and attitudes among primary care providers at an academic medical center. Cancer Epidemiology and Prevention Biomarkers. 2015; 24(4):664-670.
Smetana GW, Boiselle PM, Schwartzstein RM. Screening for lung cancer with low-dose computed tomography: grand rounds discussion from the Beth Israel Deaconess Medical Center. Annals of internal medicine. 2015; 162(8):577-582.
Kanodra NM, Pope C, Halbert CH, Silvestri GA, Rice LJ, Tanner NT. Primary Care Provider and Patient Perspectives on Lung Cancer Screening. A Qualitative Study. Ann Am Thorac Soc. 2016; 13(11):1977-1982.
Wiener RS, Koppelman E, Bolton R, et al. Patient and Clinician Perspectives on Shared Decision-making in Early Adopting Lung Cancer Screening Programs: a Qualitative Study. J Gen Intern Med. 2018; 33(7):1035-1042.
Ersek JL, Eberth JM, McDonnell KK, et al. Knowledge of, attitudes toward, and use of low‐dose computed tomography for lung cancer screening among family physicians. Cancer. 2016; 122(15):2324-2331.
Carter-Harris L, Tan AS, Salloum RG, Young-Wolff KC. Patient-provider discussions about lung cancer screening pre-and post-guidelines: Health Information National Trends Survey (HINTS). Patient education and counseling. 2016; 99(11):1772-1777.
Borkan J. Immersion/crystallization In: Crabtree BM, WL, ed. Doing qualitative research. Thousand Oaks, CA: Sage; 1999.
US Preventive Task Force (2013a). Final recommendation statement, Lung cancer: Screening. 2013; https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/lung-cancer-screening. Accessed February 14, 2019.
US Preventive Task Force (2013b); https://www.uspreventiveservicestaskforce.org/Page/Name/grade-definitions. Accessed April 16, 2018.
Fiore MC, Jaen CR, Baker T, et al. Treating tobacco use and dependence: 2008 update. Rockville, MD: US Department of Health and Human Services. 2008.
Mahoney MC, Twarozek AM, Saad-Harfouche F, et al. Assessing the delivery of cessation services to smokers in urban, safety-net clinics. Journal of community health. 2014; 39(5):879-885.
Detterbeck FC, Mazzone PJ, Naidich DP, Bach PB. Screening for lung cancer: diagnosis and management of lung cancer: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013; 143(5): e78S-e92S.
Jaklitsch MT, Jacobson FL, Austin JH, et al. The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups. The Journal of thoracic and cardiovascular surgery. 2012;144(1):33-38.
National Comprehensive Cancer Network (2018). NCCN Lung cancer screening, version 2.2019 – August 27, 2018; https://www.nccn.org/professionals/physician_gls/pdf/lung_screening.pdf. Accessed February 14, 2019.
Wender R, Fontham ET, Barrera E, et al. American Cancer Society lung cancer screening guidelines. CA: a cancer journal for clinicians. 2013; 63(2):106-117.
American Academy of Family Physicians (2019). Clinical preventive service recommendation. 2018; https://www.aafp.org/patient-care/clinical-recommendations/all/lung-cancer.html. Accessed February 14, 2019.
Centers for Disease Control and Prevention (2017a). Decision memo for screening for lung cancer low dose domputed tomotgraphy (LDCT) (CAG-00439N). 2018; https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=274. Accessed February 14, 2019.
Poonacha TK, Go RS. Level of scientific evidence underlying recommendations arising from the National Comprehensive Cancer Network clinical practice guidelines. Journal of Clinical Oncology. 2010; 29(2):186-191.
Loeb S, Vonesh EF, Metter EJ, Carter HB, Gann PH, Catalona WJ. What is the true number needed to screen and treat to save a life with prostate-specific antigen testing? Journal of clinical oncology: official journal of the American Society of Clinical Oncology. 2011; 29(4):464-467.
Richardson A. Screening and the number needed to treat. Journal of medical screening. 2001; 8(3):125-127.
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