Money issues, technology challenges and the clock are among the barriers preventing widespread adoption of lung cancer screenings. “We just don’t have enough time,” said one primary care physician at a hospital that offers such services.
That’s according to a new survey of various clinician types, published recently in the Annals of the American Thoracic Society. Though evidence of low-dose CT’s benefits is numerous, states are still struggling to implement this intervention. Wanting to better understand the obstacles, a team of researchers recently surveyed two-dozen providers, picking their brains on how to accelerate adoption.
“Despite a known mortality benefit, lung cancer screening implementation has been unexpectedly slow,” wrote Anne Melzer, an assistant professor of medicine at the University of Minnesota, and colleagues. “New programs face barriers to implementation, which may include lack of clinician engagement or beliefs that the intervention is not beneficial.”
To get to the root causes, the research team conducted qualitative interviews with providers across three academic medical centers. Those surveyed included a radiologist, a surgeon, pulmonologists, primary care providers and program coordinators.
The majority surveyed said evidence is adequate to support wider adoption. But many primary care docs expressed little direct knowledge of lung cancer screenings, including eligibility requirements and scan strategies, Melzer et al. wrote.
Those with a greater understanding on the topic noted gaps such as unclear ideal screening intervals, patient populations that do not qualify for low-dose CT under U.S. Preventative Services Task Force guidelines, and unfamiliarity with how serious comorbidities factor into clinical decision-making.
“Clinicians were frustrated by time limitations during a patient encounter, costs to the patient, and issues with insurance coverage. Many gaps in informatics support were identified,” the research team noted.
To bust some common barriers, survey respondents recommended streamlining processes—“anything to save time,” said one primary care doc—with shorter decision aids and better use of electronic health records. For the latter, EHRs might offer stronger clinical reminders, include LCS in the “health maintenance” section, facilitate communication among the care team, and streamline tracking of scans.
Public education could also help boost screening rates, Melzer and colleagues concluded.
“Clinicians in all roles felt that, despite existing guidelines, LCS was inadequately publicized to both the general public and medical staff,” they noted. “They suggested more outreach among the medical staff in addition to concerted efforts to educate the public. While other screening tests were felt to receive media attention, LCS was perceived to be outside of most patients’ awareness which was a barrier to engagement.”
You can read more about their findings in the Annals of the American Thoracic Society here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.