title: 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% confidence intervals, 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 with 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 nonrecommended 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.
  
  
  CONCLUSIONS
  This study describes some of the first data available about PCPs' use of lung cancer screening tests since the publication of multiple professional guidelines endorsing LDCT. Knowledge gaps were identified that may hinder the uptake of evidence-based lung cancer screening guidelines.
authors.affiliation: Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Lewis
authors.affiliation: Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: W Jeffrey
authors.initials: WJ
authors.lastname: Petty
authors.affiliation: Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Janet A
authors.initials: JA
authors.lastname: Tooze
authors.affiliation: Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: David P
authors.initials: DP
authors.lastname: Miller
authors.affiliation: Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Caroline
authors.initials: C
authors.lastname: Chiles
authors.affiliation: Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Antonius A
authors.initials: AA
authors.lastname: Miller
authors.affiliation: Department of Internal Medicine, Section on Pulmonology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Christina
authors.initials: C
authors.lastname: Bellinger
authors.affiliation: Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina. keweaver@wakehealth.edu.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Weaver
mesh_terms: D000046:Academic Medical Centers / Q000379:methods*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care; D011829:Radiation Dosage; D011859:Radiography; D011795:Surveys and Questionnaires; D015898:Tomography Scanners, X-Ray Computed