Primary Care Provider and Patient Perspectives on Lung Cancer Screening. A Qualitative Study.
The U.S. Preventive Services Task Force recommends annual low-dose computed tomography (LDCT) for lung cancer screening in high-risk individuals. Preventive healthcare is provided predominantly by primary care providers (PCPs). Successful implementation of a screening program requires acceptance and participation by both providers and patients, with available collaboration with pulmonologists.



To identify perceptions of and perspectives on lung cancer screening and implementation among PCPs and eligible veteran patients at high risk for lung cancer.



We conducted a qualitative study using grounded theory in which 28 veterans and 13 PCPs completed a questionnaire and participated in focus groups. Sessions were recorded, transcribed verbatim, and analyzed with NVivo 10 software. Counts and percentages were used to report questionnaire results.



While 58% percent of providers were aware of lung cancer screening guidelines, many could not recall the exact patient eligibility criteria. Most patients were willing to undergo LDCT screening and identified smoking as a risk factor for lung cancer, but they did not recall their PCP explaining the reason for the testing. All providers assessed smoking behavior, but only 23% referred active smokers for formal cessation services. Patients volunteered information regarding their hurdles with smoking cessation while discussing risk factors for cancer. PCPs cited time constraints as a reason for lack of appropriate counseling and shared decision making. Both parties were willing to explore modalities and decision aid tools to improve shared decision making; however, while patients were interested in individual risk prediction, few PCPs believed statistical approaches to counseling would confuse patients.



While patients and providers are receptive to LDCT screening, efforts are needed to improve guideline knowledge and adherence among providers. System-level interventions are necessary to facilitate time and resources for shared decision making and smoking cessation counseling and treatment. Further research is needed to identify optimal strategies for effective lung cancer screening in the community.
1 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine.
Neeti M
NM
Kanodra
3 College of Nursing, and.|2 Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Hospital, Charleston, South Carolina.
Charlene
C
Pope
4 Department of Psychiatry and Behavioral Sciences, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina; and.|2 Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Hospital, Charleston, South Carolina.
Chanita H
CH
Halbert
1 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine.
Gerard A
GA
Silvestri
4 Department of Psychiatry and Behavioral Sciences, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina; and.
LaShanta J
LJ
Rice
1 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine.|2 Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Hospital, Charleston, South Carolina.
Nichole T
NT
Tanner
D000368:Aged; D003376:Counseling; D003657:Decision Making; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D017144:Focus Groups; D066296:Grounded Theory; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation / Q000379:methods; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D014481:United States; D014728:Veterans / Q000523:psychology*
early detection of cancer; lung neoplasms; shared decision making