title: A National Survey of Pulmonologists' Views on Low-Dose Computed Tomography Screening for Lung Cancer.
abstract: BACKGROUND
  Multiple guidelines now recommend low-dose computed tomography (LDCT) screening for lung cancer. Given their central role in the planning of LDCT screening programs, pulmonologists' beliefs about LDCT screening will affect the safety, cost-effectiveness, and success of LDCT screening implementation.
  
  
  OBJECTIVE
  To assess pulmonologists' propensity to offer lung cancer screening and their perceptions about LDCT screening.
  
  
  METHODS
  We performed a national web-based survey, administered July 2013 to February 2014, among all staff pulmonologists active in Veterans Health Administration pulmonary clinics. The primary outcome was screening propensity (on the basis of responses to clinical vignettes) in relation to guidelines. Using bivariate and multinomial logistic regression, we assessed how perceptions of the evidence, trade-offs, and barriers to implementation of LDCT screening programs affected propensity to screen.
  
  
  RESULTS
  Of 573 eligible pulmonologists e-mailed, 286 (49.9%) participated. Approximately one-half (52.4%) had a propensity for guideline-concordant screening, 22.7% for overscreening, and 24.9% for underscreening. In bivariate analyses, guideline concordance was associated with acceptance of trial evidence, guidelines, and the efficacy of screening. In multivariable models, underscreeners were more likely to cite the potential harms of screening (e.g., false-positive findings, radiation exposure, incidental findings, unfavorable cost-benefit ratio), as influential factors (relative risk, 3.9; 95% confidence interval, 1.5-9.67) and were less influenced by trial evidence and guidelines (relative risk, 0.06; 95% confidence interval, 0.02-0.2), as compared with guideline-concordant screeners. Local resource availability did not significantly affect screening propensity, but insufficient infrastructure and personnel were commonly perceived barriers to implementation.
  
  
  CONCLUSIONS
  Pulmonologists have varied perceptions of the evidence and trade-offs of LDCT screening, leading to the potential for over- and underscreening. To minimize potential harms as LDCT screening is widely implemented, physicians must understand which patients are appropriate candidates and engage those patients in a shared decision-making process regarding the trade-offs of LDCT screening.
authors.affiliation: 1 The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Iaccarino
authors.affiliation: 2 Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veteran's Affairs Hospital, Bedford, Massachusetts.|3 Boston University School of Public Health, Boston, Massachusetts.
authors.forename: Jack
authors.initials: J
authors.lastname: Clark
authors.affiliation: 2 Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veteran's Affairs Hospital, Bedford, Massachusetts.
authors.forename: Rendelle
authors.initials: R
authors.lastname: Bolton
authors.affiliation: 4 National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, North Carolina.
authors.forename: Linda
authors.initials: L
authors.lastname: Kinsinger
authors.affiliation: 5 Medical Service, Durham VA Medical Center, Durham, North Carolina.|6 Duke Cancer Institute and Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Michael
authors.initials: M
authors.lastname: Kelley
authors.affiliation: 7 Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon.|8 Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Slatore
authors.affiliation: 9 Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington.|10 Division of Pulmonary Critical Care Medicine, University of Washington, Seattle, Washington; and.
authors.forename: David H
authors.initials: DH
authors.lastname: Au
authors.affiliation: 1 The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts.|2 Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veteran's Affairs Hospital, Bedford, Massachusetts.|11 The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire.
authors.forename: Renda Soylemez
authors.initials: RS
authors.lastname: Wiener
mesh_terms: D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D008403:Mass Screening; D010820:Physicians; D017410:Practice Guidelines as Topic; D014057:Tomography, X-Ray Computed; D014481:United States
keywords: early detection of cancer; health care surveys; lung neoplasms; physicians