Primary Care Provider and Patient Perspectives on Lung Cancer Screening. A Qualitative Study

Kanodra, Neeti M.; Pope, Charlene; Halbert, Chanita Hughes; Silvestri, Gerard A.; Rice, LaShanta; Tanner, Nichole T.

doi:10.1513/annalsats.201604-286oc

Cited by 108 publications

(106 citation statements)

References 21 publications

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“…These sentiments reflect the need for doctors to communicate the limitations of low-dose CT scans and the process and risks associated with follow-up diagnostic testing. However, the participants who had experience with lung cancer screening tests recalled only limited communication with their doctors about the procedure, echoing findings of another study [17]. The 2015 CMS coverage decision attempts to address this issue by requiring an initial visit for counseling and shared decision making.…”

Section: Discussionmentioning

confidence: 78%

A qualitative analysis of smokers’ perceptions about lung cancer screening

et al. 2017

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BackgroundIn 2013, the US Preventive Services Task Force (USPSTF) began recommending lung cancer screening for high risk smokers aged 55–80 years using low-dose computed tomography (CT) scan. In light of these updated recommendations, there is a need to understand smokers’ knowledge of and experiences with lung cancer screening in order to inform the design of patient education and tobacco cessation programs. The purpose of this study is to describe results of a qualitative study examining smokers’ perceptions around lung cancer screening tests.MethodsIn 2009, prior to the release of the updated USPSTF recommendations, we conducted 12 120-min, gender-specific focus groups with 105 current smokers in Charlotte, North Carolina and Cincinnati, Ohio. Focus group facilitators asked participants about their experience with three lung cancer screening tests, including CT scan, chest x-ray, and sputum cytology. Focus group transcripts were transcribed and qualitatively analyzed using constant comparative methods.ResultsParticipants were 41–67 years-old, with a mean smoking history of 38.9 pack-years. Overall, 34.3% would meet the USPSTF’s current eligibility criteria for screening. Most participants were unaware of all three lung cancer screening tests. The few participants who had been screened recalled limited information about the test. Nevertheless, many participants expressed a strong desire to pursue lung cancer screening. Using the social ecological model for health promotion, we identified potential barriers to lung cancer screening at the 1) health care system level (cost of procedure, confusion around results), 2) cultural level (fatalistic beliefs, distrust of medical system), and 3) individual level (lack of knowledge, denial of risk, concerns about the procedure). Although this study was conducted prior to the updated USPSTF recommendations, these findings provide a baseline for future studies examining smokers’ perceptions of lung cancer screening.ConclusionWe recommend clear and patient-friendly educational tools to improve patient understanding of screening risks and benefits and the use of best practices to help smokers quit. Further qualitative studies are needed to assess changes in smokers’ perceptions as lung cancer screening with CT scan becomes more widely used in community practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4496-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 78%

A qualitative analysis of smokers’ perceptions about lung cancer screening

et al. 2017

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“…The managerial issue of sparse resources for smoking cessation interventions was identified in over a third of the publications reviewed. This widespread recognition was expected, given the number of previous publications that have referenced the issue (Earnshaw et al, 2002;Kanodra et al, 2016;Sarna et al, 2009).…”

Section: (17%)mentioning

confidence: 89%

Systematic Review of Clinician-Reported Barriers to Provision of Smoking Cessation Interventions in Hospital Inpatient Settings

et al. 2018

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B ackground: Although the hospital inpatient setting arguably provides an ideal opportunity to engage patients in smoking cessation interventions, this is done infrequently. We therefore aimed to systematically review the perceived barriers to the implementation of smoking cessation interventions in the hospital inpatient setting. Methods: A systematic literature search was conducted specific to hospital-based healthcare workers' perceived barriers to implementing smoking cessation interventions. Reported barriers were categorised using the capability, opportunity and motivation (COM-B) framework. Results: Eighteen studies were selected for inclusion, which consisted of cross-sectional surveys and interviews. The most commonly identified barrier in capability was lack of knowledge (56% of studies); in Opportunity, it was a lack of time (78%); while in Motivation, a lack of perceived patient motivation to quit smoking (44%). Seventeen other barriers were also endorsed, but less frequently. Conclusion: Healthcare workers report a plethora of barriers to providing smoking cessation interventions in hospital settings, which cover all aspects of the COM-B framework. These impediments need to be addressed in a multidisciplinary approach, at clinical, educational, and administrative levels, to improve intervention provision.

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“…Another factor found to be a major barrier in our study was a lack of counseling regarding LDCT. In a recent study, time constraints were cited by primary care physicians as a reason for the lack of appropriate counseling and shared decision making for lung cancer screening [8]. This especially holds true for public sector settings in Pakistan, where already-overworked doctors are required to cater to large numbers of patients in a limited time frame, making each doctor-patient interaction necessarily brief.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Barriers to Lung Cancer Screening in Karachi, Pakistan: A Cross-Sectional Survey of Smokers and Physicians

Abbasi¹,

Siddiqi²,

Owais³

et al. 2017

Cureus

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BackgroundEarly detection of lung cancer using low-dose computed tomography (LDCT) can potentially reduce morbidity and mortality. However, LDCT for lung cancer screening, especially in low income countries, has been underutilized. The objective of this study was to evaluate the prevalence and the potential personal, social, and economic barriers of lung cancer screening using LDCT.MethodsA total sample of 156 smokers and 200 general physicians was collected during December 2016-February 2017 from community settings in Karachi, Pakistan. Two separate questionnaires were constructed to characterize participants’ knowledge, attitudes, and practices regarding lung cancer screening. Screening-eligible smokers and physicians were asked to identify patient barriers to screening and were asked their opinion regarding most effective approach for increasing awareness of screening guidelines.ResultsThe majority of smokers' (n=91, 58.3%) and physicians' (n=131, 65.7%) beliefs about the US Preventive Services Task Force (USPSTF) eligibility criteria were inconsistent with the actual recommendations. Major barriers to screening included financial cost, lack of patient counseling and health anxiety related to screening. Over two-thirds (n=105, 67.3%) of smokers were receptive to further information about LDCT screening, and half (n=78, 50.0%) favored one-on-one counseling by their physician, compared to other media. Only one-third (n=65, 33.3%) of physicians reported use of LDCT screening, although 54.5% (n=108) felt that screening implementation would be very effective in their practice.ConclusionLDCT screening is currently an uncommon practice in Pakistan. Financial cost, inadequate doctor-patient communication, and lack of awareness of guidelines among both patients and physicians are the major barriers in the utilization of LDCT screening.

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Primary Care Provider and Patient Perspectives on Lung Cancer Screening. A Qualitative Study

Cited by 108 publications

References 21 publications

A qualitative analysis of smokers’ perceptions about lung cancer screening

A qualitative analysis of smokers’ perceptions about lung cancer screening

Systematic Review of Clinician-Reported Barriers to Provision of Smoking Cessation Interventions in Hospital Inpatient Settings

Prevalence and Barriers to Lung Cancer Screening in Karachi, Pakistan: A Cross-Sectional Survey of Smokers and Physicians

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