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Multilevel Study of Lung Cancer Screening Guidelines Implementation

Institution: Palo Alto Medical Foundation Research Institute
Investigator(s): Jiang Li, Ph.D.
Award Cycle: 2018 (Cycle 27) Grant #: 27KT-0001 Award: $886,353
Subject Area: Cancer
Award Type: New Investigator Awards

Initial Award Abstract

In 2013, the U.S. Preventive Services Task Force (USPSTF) began recommending lung cancer screening (LCS) with low-dose computed tomography (LDCT) for heavy smokers. In 2015, this became a covered Medicare benefit. To increase effectiveness, the USPSTF also recommends coupling LDCT for LCS with smoking cessation counseling. Together, LCS with LDCT and smoking cessation can be cost effective in reducing the burden of lung cancer. However, many barriers such as time constraint, cost, lack of awareness, or even lack of trust in healthcare systems can impact utilization of the LCS with LDCT in clinical settings. Furthermore, screening for lung cancer is not a single test but involves multiple components: determining eligibility, shared decision making, referral for screening, smoking cessation counseling, the LDCT screening test, interpretation of results, and follow-up management. Minimal research has attempted to describe the whole process and explore the comprehensive picture of barriers and facilitators from a multilevel, multifactor perspective.

This study seeks to explore the barriers faced by patients, providers, and healthcare system in each stage of the screening process, and to identify practice approaches leading to better implementation of screening with LDCT in a large community healthcare system in northern California. Using data from the perspectives of patients, providers, and clinics, we will look at changes in screening and counseling practices. We hypothesize that there is an increase in smoking history documentation, medical orders, and screening rates after the 2013 USPSTF guideline, but that there is substantial differences across providers and clinics in the implementation of these practices. We will also conduct in-person interviews with patients and providers to get a firsthand account of the challenges faced when implementing LCS with LDCT.

Findings from this study have the potential to assist the public health community with both design and dissemination of best practices for LCS with LDCT, to promote smoking cessation, and ultimately to help reduce lung cancer mortality in California.