E5032. Elucidating Barriers to Low-Dose CT Lung Cancer Screening From the Provider's Perspective
Authors
Jeffrey Quezada;
University of California Irvine School of Medicine
Axs Avenido;
University of California Irvine School of Medicine
Stephanie Jia;
University of California Irvine School of Medicine
Arsanyous Bernaba;
University of California Irvine School of Medicine
Sabrina Nguyen;
University of California Irvine School of Medicine
Shayan Gharagozlou;
No Affiliation
Gelareh Sadigh;
University of California Irvine School of Medicine
Objective:
Low-dose CT (LDCT) for lung cancer screening (LCS) continues to be underutilized, despite its broad support amongst multiple professional societies, including the United States Preventive Services Task Force, American Cancer Society, and the National Comprehensive Cancer Network, and its demonstrated mortality benefit compared to chest radiography. Survey research evaluating barriers to LCS with LDCT from the provider’s perspective exists, but it is largely limited to primary care physicians within the academic medical setting and not fully reflective of the diversity of healthcare settings, provider backgrounds, or patient populations. Our study aims to broaden existing knowledge by assessing barriers across the diverse populations of California from the viewpoint of family medicine, internal medicine, geriatric medicine, and pulmonology physicians in both academic and community settings.
Materials and Methods:
Providers in four different practice settings within California were surveyed to assess knowledge of LDCT screening criteria, LCS practices, and barriers to the use of LDCT scan screening. Knowledge scores were calculated for each respondent based on their responses to nine questions based on CMS eligibility criteria (six correct, three incorrect), with a total score range from 0–9 points (+1 for selecting each correct criterion and +1 for not selecting each incorrect criterion). The Likert scale was used to assess providers’ perceptions regarding barriers to the utilization of LCS and providers’ knowledge about screening guidelines. Responses were dichotomized to create binary responses that were then evaluated with the chi-square test.
Results:
To date, 27 providers have completed the survey comprised of 13 internists, 11 family practitioners, and two pulmonologists. A total of 19 (70%) ordered a LDCT for LCS within the last 12 months. Overall, only one (4%) respondent correctly identified all six CMS eligibility criteria when challenged with three incorrect criteria. Average knowledge score was 5.86 ± 1.5 and did not significantly differ based on practice setting, level of training, or years of practice. Common barriers to utilization of LDCT screening included the inaccuracy of documented smoking history in the EMR (56%), cost of follow-up imaging/procedures that might be needed after LDCT (41%), failure of the EMR to notify providers of eligible patients (37%), and cost of LDCT for patients (30%). The majority (81%) of providers felt comfortable initiating a shared decision-making discussion with a patient considering LCS.
Conclusion:
Provider knowledge of LDCT screening criteria is suboptimal and may contribute to its underutilization as a screening tool for lung cancer. Improvement of educational resources for providers and augmentation of EMR smart tools to update documented smoking histories and notify providers of eligible patients may improve the rate of LCS.
