Lung cancer is the leading cause of cancer death in the U.S. among both men and women. In 2010, results from the National Lung Screening Trial, which compared low-dose computed tomography (LDCT) screening to chest radiography, found a 20% reduction in lung cancer mortality among individuals at high risk who received LDCT. Based on these results, and after evaluating the benefits and harms, the United States Preventive Services Task Force recommended annual lung cancer screening with LDCT scans for high-risk patients. Recently, the Centers for Medicare and Medicaid Services announced the decision to cover LDCT for lung cancer screening. Considering these recommendations, patients, together with their physicians, should weigh currently known benefits with limitations and risks to make an informed and shared decision about being screened.
Any discussion of lung cancer screening should be coupled with culturally and linguistically personalized information about risk and potential benefits, harms, limitations, and associated costs. Although primary care physicians (PCPs) are central to the discussion of lung cancer screening and shared decision making, they may lack tools and information to facilitate these discussions with patients. In addition, patients lack the personalized information to determine their own risk and to evaluate the benefits and harms of lung cancer screening. However, there are no standards for conducting these discussions, particularly with patients of limited health literacy, limited English proficiency or from diverse cultural backgrounds.
Our study will assess the barriers and facilitators of lung cancer screening among a multiethnic population and determine the best methods and messages for communicating risk, benefits, and options for lung cancer screening. We will determine the barriers (psychosocial, financial, system) to physician-patient discussions concerning lung cancer risk and lung cancer screening, and determine what might facilitate those discussions and encourage SDM. We will evaluate patient and PCP perspectives and concerns individually. The following specific aims will help us to accomplish our overall goals:
- In Aim 1 we will conduct a qualitative assessment of patient and PCP factors associated with LDCT lung cancer screening. Specifically, we will assess patients’ understanding of LDCT screening; practices, attitudes and beliefs toward LDCT screening; barriers and facilitators to LDCT screening including access, and the preferred methods of communication of risk, benefits and harms during LDCT screening discussions. To achieve this goal we will conduct in-depth semi-structured interviews with patients who have not received and those who have received LDCT screening
We will also assess PCPs’ understanding of LDCT screening, attitudes and beliefs toward LDCT screening, perceived system-, physician- and patient-level barriers and facilitators to LDCT screening, preferred methods of communication during screening discussions and preferred methods of receiving information at primary care clinics. We will conduct semi-structured interviews with PCPs identified in the San Francisco Bay Area
- In Aim 2 we will conduct a survey of PCPs practicing in the San Francisco Bay Area to assess lung cancer screening practices, attitudes and beliefs. To achieve this aim, we will develop, implement and analyze data from a self-administered survey regarding PCPs’ knowledge, attitudes, behaviors and perceived barriers to discussion and referral of patients for lung cancer screening. Based on the data collected in Aim 1, we will develop and implement the survey with 500 PCPs from the San Francisco Bay area recruited though the American Medical Association Masterfile.
We expect our research to provide specific recommendations that will inform an intervention to facilitate patient-PCP discussions about LDCT screening and promote shared decision-making among ethnically diverse patients.