title: Patient and primary care provider attitudes and adherence towards lung cancer screening at an academic medical center.
abstract: Low dose CT (LDCT) for lung cancer screening is an evidence-based, guideline recommended, and Medicare approved test but uptake requires further study. We therefore conducted patient and provider surveys to elucidate factors associated with utilization. Patients referred for LDCT at an academic medical center were questioned about their attitudes, knowledge, and beliefs on lung cancer screening. Adherent patients were defined as those who met screening eligibility criteria and completed a LDCT. Referring primary care providers within this same medical system were surveyed in parallel about their practice patterns, attitudes, knowledge and beliefs about screening. Eighty patients responded (36%), 48 of whom were adherent. Among responders, non-Hispanic patients (p= 0.04) were more adherent. Adherent respondents believed that CT technology is accurate and early detection is useful, and they trusted their providers. A majority of non-adherent patients (79%) self-reported an intention to obtain a LDCT in the future. Of 36 of 87 (41%) responding providers, only 31% knew the correct lung cancer screening eligibility criteria, which led to a 37% inappropriate referral rate from 2013 to 2015. Yet, 75% had initiated lung cancer screening discussions, 64% thought screening was at least moderately effective, and 82% were interested in learning more of the 33 providers responding to these questions. Overall, patients were motivated and providers engaged to screen for lung cancer by LDCT. Non-adherent patient "procrastinators" were motivated to undergo screening in the future. Additional follow through on non-adherence may enhance screening uptake, and raising awareness for screening eligibility through provider education may reduce inappropriate referrals.
authors.affiliation: Santa Clara Valley Medical Center, Department of Medicine, San Jose, CA, United States; Stanford University School of Medicine, Division of Pulmonary & Critical Care Medicine, Stanford, CA, United States.
authors.forename: Duy K
authors.initials: DK
authors.lastname: Duong
authors.affiliation: Cancer Prevention Institute of California, Fremont, CA, United States; Stanford Cancer Institute, Stanford, CA, United States.
authors.forename: Salma
authors.initials: S
authors.lastname: Shariff-Marco
authors.affiliation: Cancer Prevention Institute of California, Fremont, CA, United States; Stanford Cancer Institute, Stanford, CA, United States.
authors.forename: Iona
authors.initials: I
authors.lastname: Cheng
authors.affiliation: Stanford University School of Medicine, Department of Radiology, Stanford, CA, United States; Stanford University School of Medicine, Division of Pulmonary & Critical Care Medicine, Stanford, CA, United States.
authors.forename: Harris
authors.initials: H
authors.lastname: Naemi
authors.affiliation: Cancer Prevention Institute of California, Fremont, CA, United States.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Moy
authors.affiliation: Stanford University School of Medicine, Department of Health & Research Policy, Stanford, CA, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: Haile
authors.affiliation: Stanford University School of Medicine, Department of General Medical Disciplines, Stanford, CA, United States.
authors.forename: Baldeep
authors.initials: B
authors.lastname: Singh
authors.affiliation: Stanford University School of Medicine, Department of Radiology, Stanford, CA, United States.
authors.forename: Ann
authors.initials: A
authors.lastname: Leung
authors.affiliation: Stanford Cancer Institute, Stanford, CA, United States; Stanford University School of Medicine, Stanford Prevention Research Center, Stanford, CA, United States.
authors.forename: Ann
authors.initials: A
authors.lastname: Hsing
authors.affiliation: Stanford University School of Medicine, Department of Radiology, Stanford, CA, United States; Stanford University School of Medicine, Division of Pulmonary & Critical Care Medicine, Stanford, CA, United States.
authors.forename: Viswam S
authors.initials: VS
authors.lastname: Nair
keywords: Early detection of cancer; Lung neoplasms; Surveys and questionnaires