A national survey of primary care physicians: Perceptions and practices of low-dose CT lung cancer screening

Abstract

Soon after the National Lung Screening Trial, organizations began to endorse low-dose computed tomography (LCDT) screening for lung cancer in high-risk patients. Concerns about the risks versus benefits of screening, as well as the logistics of identifying and referring eligible patients, remained among physicians. This study aimed to examine primary care physicians' knowledge, attitudes, referral practices, and associated barriers regarding LDCT screening. We administered a national survey of primary care physicians in the United States between September 2016 and April 2017. Physicians received up to 3 mailings, 1 follow-up email, and received varying incentives to complete the survey. Overall, 293 physicians participated, for a response rate of 13%. We used weighted descriptive statistics to characterize participants and their responses. Over half of the respondents correctly reported that the US Preventive Services Task Force recommends LDCT screening for high-risk patients. Screening recommendations for patients not meeting high-risk criteria varied. Although 75% agreed that the benefits of LDCT screening outweigh the risks, fewer agreed that there is substantial evidence that screening reduces mortality (50%). The most commonly reported barriers to ordering screening included prior authorization requirements (57%), lack of insurance coverage (53%), and coverage denials (31%). The most frequently cited barrier to conducting LDCT screening shared decision making was patients' competing health priorities (42%). Given the impact of physician recommendations on cancer screening utilization, further understanding of physicians' LDCT screening attitudes and shared decision-making practices is needed. Clinical practice and policy changes are also needed to engage more patients in screening discussions.

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

“…8,9 An increased rate of LCS referral since 2013 is consistent with a recent national study in which 36% of providers reported ordering 1 to 5 tests in the past year. 24 However, ,1% of gynecologists and only 39% of hematology/oncology providers reported performing LDCT screening in the past year in our study. Having a patient population that is ineligible for screening (ie, younger nonsmokers) or assuming that another provider is addressing cancer screening may explain lower knowledge or rates of screening among these providers.…”

“…Consistent with prior studies, many providers still report ordering screening chest radiographs, which is not a recommended screening test. 4,11,13,19,21,24 It is not surprising that there were more providers with low LCS knowledge who reported ordering screening chest radiographs. However, to our knowledge, this is the first study showing this relationship, and this finding further strengthens the relationship between guideline knowledge and LCS.…”

Developing and testing a brief clinic‐based lung cancer screening decision aid for primary care settings

“…However, perceived time constraints are the most frequently cited barrier to proposed change in clinical settings. Findings from a recently completed national survey of 810 PCPs (430 medical doctors and 380 nurse practitioners in the U.S.) indicated that only 30% and 37%, respectively, would be likely to engage in an SDM discussion with a patient if the time commitment was greater than 8 minutes . In this sense, implementing SDM may be no different from implementing any other practice improvement .…”

COUNTERPOINT: Can Shared Decision-Making of Physicians and Patients Improve Outcomes in Lung Cancer Screening? No

“…For instance, 75% of PCPs reported in a national survey that the benefits of screening outweigh the harms but only 5% had actually billed CMS for a shared decision-making visit. 23 They reported many procedural barriers to shared decisionmaking such as competing patient priorities and lack of time: 67% indicated they would not engage in shared decision-making if it took > 8 min.…”