title: Readiness for Implementation of Lung Cancer Screening. A National Survey of Veterans Affairs Pulmonologists.
abstract: To mitigate the potential harms of screening, professional societies recommend that lung cancer screening be conducted in multidisciplinary programs with the capacity to provide comprehensive care, from screening through pulmonary nodule evaluation to treatment of screen-detected cancers. The degree to which this standard can be met at the national level is unknown.
  
  
  
  To assess the readiness of clinical facilities in a national healthcare system for implementation of comprehensive lung cancer screening programs, as compared with the ideal described in policy recommendations.
  
  
  
  This was a cross-sectional, self-administered survey of staff pulmonologists in pulmonary outpatient clinics in Veterans Health Administration facilities.
  
  
  
  The facility-level response rate was 84.1% (106 of 126 facilities with pulmonary clinics); 88.7% of facilities showed favorable provider perceptions of the evidence for lung cancer screening, and 73.6% of facilities had a favorable provider-perceived local context for screening implementation. All elements of the policy-recommended infrastructure for comprehensive screening programs were present in 36 of 106 facilities (34.0%); the most common deficiencies were the lack of on-site positron emission tomography scanners or radiation oncology services. Overall, 26.5% of Veterans Health Administration facilities were ideally prepared for lung cancer screening implementation (44.1% if the policy recommendations for on-site positron emission tomography scanners and radiation oncology services were waived).
  
  
  
  Many facilities may be less than ideally positioned for the implementation of comprehensive lung cancer screening programs. To ensure safe, effective screening, hospitals may need to invest resources or coordinate care with facilities that can offer comprehensive care for screening through downstream evaluation and treatment of screen-detected cancers.
authors.affiliation: 1 Division of Pulmonary, Critical Care & Sleep, Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Melissa H
authors.identifier: 0000-0002-1085-2560
authors.initials: MH
authors.lastname: Tukey
authors.affiliation: 2 Center for Healthcare Organization & Implementation Research, Edith Nourse Rogers Memorial Veterans Affairs Hospital, Bedford, Massachusetts.|3 Boston University School of Public Health and.
authors.forename: Jack A
authors.initials: JA
authors.lastname: Clark
authors.affiliation: 2 Center for Healthcare Organization & Implementation Research, Edith Nourse Rogers Memorial Veterans Affairs Hospital, Bedford, Massachusetts.
authors.forename: Rendelle
authors.initials: R
authors.lastname: Bolton
authors.affiliation: 4 Medical Service, Durham Veterans Affairs Medical Center, Durham, North Carolina.|5 Duke Cancer Institute and Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kelley
authors.affiliation: 6 Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon.|7 Division of Pulmonary & Critical Care Medicine, Oregon Health & Science University, Portland, Oregon.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Slatore
authors.affiliation: 8 Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.|9 Division of Pulmonary Critical Care Medicine, University of Washington, Seattle, Washington; and.
authors.forename: David H
authors.initials: DH
authors.lastname: Au
authors.affiliation: 2 Center for Healthcare Organization & Implementation Research, Edith Nourse Rogers Memorial Veterans Affairs Hospital, Bedford, Massachusetts.|10 The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts.|11 The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.
authors.forename: Renda Soylemez
authors.initials: RS
authors.lastname: Wiener
mesh_terms: D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer; D006284:Health Plan Implementation / Q000458:organization & administration*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D008403:Mass Screening; D000072106:Pulmonologists; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D014481:United States; D058014:Veterans Health
keywords: early detection of cancer; health plan implementation; healthcare economics and organizations; lung neoplasms; surveys and questionnaires