title: Attitudes and Beliefs of Primary Care Providers in New Mexico About Lung Cancer Screening Using Low-Dose Computed Tomography.
abstract: BACKGROUND
  On the basis of results from the National Lung Screening Trial (NLST), national guidelines now recommend using low-dose computed tomography (LDCT) to screen high-risk smokers for lung cancer. Our study objective was to characterize the knowledge, attitudes, and beliefs of primary care providers about implementing LDCT screening.
  
  
  METHODS
  We conducted semistructured interviews with primary care providers practicing in New Mexico clinics for underserved minority populations. The interviews, conducted from February through September 2014, focused on providers' tobacco cessation efforts, lung cancer screening practices, perceptions of NLST and screening guidelines, and attitudes about informed decision making for cancer screening. Investigators iteratively reviewed transcripts to create a coding structure.
  
  
  RESULTS
  We reached thematic saturation after interviewing 10 providers practicing in 6 urban and 4 rural settings; 8 practiced at federally qualified health centers. All 10 providers promoted smoking cessation, some screened with chest x-rays, and none screened with LDCT. Not all were aware of NLST results or current guideline recommendations. Providers viewed study results skeptically, particularly the 95% false-positive rate, the need to screen 320 patients to prevent 1 lung cancer death, and the small proportion of minority participants. Providers were uncertain whether New Mexico had the necessary infrastructure to support high-quality screening, and worried about access barriers and financial burdens for rural, underinsured populations. Providers noted the complexity of discussing benefits and harms of screening and surveillance with their patient population.
  
  
  CONCLUSIONS
  Providers have several concerns about the feasibility and appropriateness of implementing LDCT screening. Effective lung cancer screening programs will need to educate providers and patients to support informed decision making and to ensure that high-quality screening can be efficiently delivered in community practice.
authors.affiliation: University of New Mexico School of Medicine, University of New Mexico Cancer Center, Albuquerque Veterans Affairs Medical Center, Albuquerque, New Mexico.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Hoffman
authors.affiliation: University of New Mexico Cancer Center and Department of Family Medicine and Community Medicine, Albuquerque, New Mexico.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Sussman
authors.affiliation: Department of Anthropology, University of Maryland, College Park, Maryland.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Getrich
authors.affiliation: University of New Mexico Cancer Center and Department of Family Medicine and Community Medicine, Albuquerque, New Mexico.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Rhyne
authors.affiliation: University of New Mexico School of Medicine and University of New Mexico Cancer Center, Albuquerque, New Mexico.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Crowell
authors.affiliation: Georgetown Lombardi Comprehensive Cancer Center and Georgetown University Medical Center, Washington, DC.
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Taylor
authors.affiliation: Healthwise, Boise, Idaho.
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: Reifler
authors.affiliation: Healthwise, Boise, Idaho.
authors.forename: Pamela H
authors.initials: PH
authors.lastname: Wescott
authors.affiliation: Clinical and Translational Science Center, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.
authors.forename: Ambroshia M
authors.initials: AM
authors.lastname: Murrietta
authors.affiliation: University of New Mexico School of Medicine and University of New Mexico Cancer Center, Albuquerque, New Mexico.
authors.forename: Ali I
authors.initials: AI
authors.lastname: Saeed
authors.affiliation: Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM 87131. Email: smishra@salud.unm.edu. Dr Mishra is also affiliated with the University of New Mexico Cancer Center and the Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico.
authors.forename: Shiraz I
authors.initials: SI
authors.lastname: Mishra
mesh_terms: D037001:Directive Counseling / Q000706:statistics & numerical data; D055088:Early Detection of Cancer / Q000379:methods / Q000523:psychology; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D007722:Health Knowledge, Attitudes, Practice; D006284:Health Plan Implementation; D006801:Humans; D007407:Interviews as Topic; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000517:prevention & control; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000592:standards; D008507:Medically Underserved Area; D009516:New Mexico; D010823:Physician Assistants / Q000523:psychology; D058007:Physicians, Primary Care / Q000523:psychology*; D011314:Preventive Health Services / Q000706:statistics & numerical data; D011369:Professional-Patient Relations; D036301:Qualitative Research; D011829:Radiation Dosage; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods*