Provider and patient perspectives to improve lung cancer screening with low-dose computed tomography 5 years after Medicare coverage: a qualitative study

Abstract

Lung cancer remains the leading cause of cancer-related deaths for both men and women in the U.S., yet uptake of preventive cancer screening for people with a heavy smoking history remains low. This qualitative interview study of patients and providers from a large ambulatory healthcare system in northern and central California reevaluated perceptions of lung cancer screening with low-dose computed tomography (LCS-LDCT) 5 years after Medicare coverage. We hypothesized that initial attitudes and barriers within the LCS-LDCT discussion and process have likely persisted with little change since Medicare coverage and we sought to understand how these attitudes continue to impact effective implementation and uptake of screening with the goal of identifying opportunities for improvement. Between 2019 and 2020, interviews were conducted with 10 primary care physicians and 30 patients using semi-structured interview guides. Providers and patients expressed that they were both aware and supportive of LCS-LDCT, a change from earlier studies, but continued to report little to no shared decision making nor use of a decision aid despite being Medicare requirements. Creation and incorporation of a single-page, graphic heavy decision aid may help address many of the persistent barriers around implementation for both providers and patients. Given recently expanded guidelines from the U.S. Preventive Services Task Force for LCS-LDCT screening and their coverage by Medicare, it is important for healthcare systems to understand provider and patient perceptions to further improve the implementation of LCS-LDCT to ultimately reduce lung cancer mortality.

Exploration of experiences and attitudes associated with lung health promotion among Black males with a history of smoking

“…However, for LDCT to achieve the maximum public health benefit, interventions to increase the awareness and uptake of lung cancer screening among smokers in the general population and groups of smokers with known barriers to healthcare access are warranted [29,[51][52][53][54]. Consistent with the extant literature [55][56][57][58], our study participants' knowledge and awareness of LDCT lung cancer screening was minimal. Due to a limited understanding of lung cancer screening, participants were provided a brief description of the process to gauge interest, attitudes and potential concerns.…”

Examination of provider knowledge, attitudes, and behaviors associated with lung cancer screening among Black men receiving care at a federally qualified health center

“…Healthcare providers can positively impact patients' cancer screening activities (Peterson et al, 2016 ) with direct recommendations by providers increasing initial and routine screening among patients (Martinez et al, 2022 ). However, barriers to provider-assisted lung cancer screening have been identified, including a lack of knowledge about screening guidelines, insurance coverage, and shared decision-making, to name a few (Zeliadt et al, 2018 ).…”