Low Rates of Patient-Reported Physician–Patient Discussion about Lung Cancer Screening among Current Smokers: Data from Health Information National Trends Survey

Abstract

Background: Many professional societies published guidelines recommending lung cancer screening with lowdose CT scan. We examined the temporal trends in patientreported physician-patient discussions about lung cancer screening, and aimed to determine the association of discussions of lung cancer screening with the smokers' attempt to quit and intent to quit.Methods: Data from years 2012, 2014, and 2017 of the National Cancer Institute's Health Information National Trends Survey (HINTS) were combined to create a multipleyear analytic dataset. We calculated the association between samples' characteristics and the presence of discussion about lung cancer screening. Using logistic regression, we estimated the probability of smokers' attempt to quit and intent to quit.Results: Among 9,443 subjects, the crude estimated rates of physician-patient discussion decreased from 6.7% in 2012, to 4.2% in 2014 and 4.3% in 2017. Across the age and smoking status groups, the current smokers ages 55 to 74 in 2012 (26.8%), and current smokers older than 74 years in 2014 (23.5%) and 2017 (22.1%) had the highest rates of discussion. The physician-patient discussion about lung cancer screening was not associated with patients' intent to quit or attempt to quit in a multivariable analysis.Conclusions: Efforts are needed to improve the physicianpatient discussion about lung cancer screening among individuals across a spectrum of lung cancer risk.Impact: Developing communication strategies for promoting beneficial lung cancer screening among lung cancer screening-eligible smokers and strategies for improving the quality of discussion on lung cancer screening integrating smoking cessation are needed to reduce the burden of lung cancer.

Promoting Clinical Conversations about Lung Cancer Screening: Exploring the Role of Perceived Online Social Support

“…Over half (53%) of the participants in this study reported having talked to their healthcare provider about lung cancer in the past year, which is considerably higher than what has been reported in prior research (Carter-Harris et al 2016;Huo et al 2019). Current and former smokers, and participants reporting less than a 30 pack-year (PPY) smoking prevalence, being outside of the 55-80 years old eligibility age-range, and identifying as male had greater odds of talking to a healthcare provider in the past year about lung cancer screening.…”

“…Participants with any history of smoking tobacco and reporting less than a 30 pack-year (PPY) smoking tobacco prevalence had high odds of talking with their healthcare provider about lung cancer screening in the past year. This is unique to prior research examining US population-based surveillance data, which found that being a current smoker increases the likelihood of having talked to a healthcare provider about lung cancer in the past year (Carter-Harris et al, 2016;Huo et al, 2019). Once controlling for the perceived availability of online instrumental and emotional support, however, results demonstrated that identifying as a current smoker, male, and living with COPD increased the odds of these clinical conversations in the past year.…”

“…Patient-provider communication about lung cancer screening is consistently low across most socio-demographics, including race, gender, income and education (Carter-Harris et al, 2016;Huo et al, 2019). National surveillance data of US adults who meet age-eligibility requirements for USPSTF-supported lung cancer screening demonstrate that providers are most likely to engage in conversations about screening with current tobacco smokers (Carter-Harris et al, 2016;Huo et al, 2019). This is problematic because lung cancer screening eligibility is also determined by historical prevalence of smoking tobacco (i.e., 30 PPY or more) among former and current smokers (USPSTF, 2013).…”

Screening for Lung Cancer — 10 States, 2017

“…Evidence-based tobacco cessation interventions in the 2008 U.S. Public Health Service clinical guidelines and The Community Guide include advising patients to quit smoking, providing cessation counseling and medications, and connecting patients to other cessation resources such as 1-800-QUIT-NOW (6). Recent studies suggest that training primary care providers on how to conduct shared decision-making discussions and implement effective smoking cessation interventions in the context of lung cancer screening is needed (7,8).…”

The Influence of Increasing Levels of Provider-Patient Discussion on Quit Behavior: An Instrumental Variable Analysis of a National Survey

“…Despite this five-step guideline, and studies showing positive effects of a provider’s discussion in helping smokers quit, the uptake of provider–patient discussion remains suboptimal [ 1 , 5 ]. Based on nationally representative samples from the National Health Interview Survey (NHIS), the prevalence of provider–patient discussion about smoking (the first A: ask) ranged from 51.3% in 2011 to 55.4% in 2015 [ 6 , 7 ]. The prevalence of patient–provider discussion on quitting (the second A: advise) ranged from 53.3% in 2000, and 58.9% in 2005, to 50.7% in 2010, and was 57.2% in 2015 [ 8 , 9 ].…”