Low-Dose CT Lung Cancer Screening Practices and Attitudes among Primary Care Providers at an Academic Medical Center

Abstract

Background Low-dose computed tomography (LDCT) screening reduces lung cancer-specific and overall mortality. We sought to assess lung cancer screening practices and attitudes among primary care providers (PCPs) in the era of new LDCT screening guidelines. Methods In 2013, we surveyed PCPs at an academic medical center (60% response) and assessed: lung cancer screening use, perceived screening effectiveness, knowledge of screening guidelines, perceived barriers to LDCT use, and interest in LDCT screening education. Results Few PCPs (n=212) reported ordering lung cancer screening: chest x-ray (21%), LDCT (12%), and sputum cytology (3%). Only 47% of providers knew three or more of six guideline components for LDCT screening; 24% did not know any guideline components. In multiple logistic regression analysis, providers who knew three or more guideline components were more likely to order LDCT (OR 7.1, 95% CI 2.0-25.6). Many providers (30%) were unsure of the effectiveness of LDCT. Mammography, colonoscopy, and Pap smear were rated more frequently as effective in reducing cancer mortality compared to LDCT (all p-values < 0.0001). Common perceived barriers included patient cost (86.9% major or minor barrier), harm from false positives (82.7%), patients’ lack of awareness (81.3%), risk of incidental findings (81.3%), and insurance coverage (80.1%). Conclusions LDCT lung cancer screening is currently an uncommon practice at an academic medical center. PCPs report ordering chest x-ray, a non-recommended screening test, more often than LDCT. PCPs had a limited understanding of lung cancer screening guidelines and LDCT effectiveness. Provider educational interventions are needed to facilitate shared-decision making with patients.

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Attitudes About Lung Cancer Screening: Primary Care Providers Versus Specialists

“…Other studies have shown that that some PCPs felt that lung cancer screening is not as efficacious as other cancer screening programs such as those for breast or colorectal cancer. 19,20 However based on NLST data, one lung cancer death is prevented with every 320 people screened. 4 This is about equivalent to other cancer screening tests, thus indicating a need for more education among PCPs about the efficacy of lung cancer screening.…”

Identifying Community Perspectives for a Lung Cancer Screening Awareness Campaign in Appalachia Kentucky: The Terminate Lung Cancer (TLC) Study

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