Low Provider Knowledge Is Associated With Less Evidence-Based Lung Cancer Screening

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  • a Geriatric Research, Education and Clinical Center, Veterans Health Administration – Tennessee Valley Healthcare System, Nashville, Tennessee;
  • b Division of Hematology/Oncology, Department of Medicine, and
  • c Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee;
  • d Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina;
  • e Department of Radiology,
  • f Division of General Internal Medicine and Public Health, Department of Medicine, and
  • g Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; and
  • h Department of Medicine, Veterans Health Administration – Tennessee Valley Healthcare System, Nashville, Tennessee.
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Background: Despite widespread recommendation and supportive policies, screening with low-dose CT (LDCT) is incompletely implemented in the US healthcare system. Low provider knowledge of the lung cancer screening (LCS) guidelines represents a potential barrier to implementation. Therefore, we tested the hypothesis that low provider knowledge of guidelines is associated with less provider-reported screening with LDCT. Patients and Methods: A cross-sectional survey was performed in a large academic medical center and affiliated Veterans Health Administration in the Mid-South United States that comprises hospital and community-based practices. Participants included general medicine providers and specialists who treat patients aged >50 years. The primary exposure was LCS guideline knowledge (US Preventive Services Task Force/Centers for Medicare & Medicaid Services). High knowledge was defined as identifying 3 major screening eligibility criteria (55 years as initial age of screening eligibility, smoking status as current or former smoker, and smoking history of ≥30 pack-years), and low knowledge was defined as not identifying these 3 criteria. The primary outcome was self-reported LDCT order/referral within the past year, and the secondary outcome was screening chest radiograph. Multivariable logistic regression evaluated the adjusted odds ratio (aOR) of screening by knowledge. Results: Of 625 providers recruited, 407 (65%) responded, and 378 (60.5%) were analyzed. Overall, 233 providers (62%) demonstrated low LCS knowledge, and 224 (59%) reported ordering/referring for LDCT. The aOR of ordering/referring LDCT was less among providers with low knowledge (0.41; 95% CI, 0.24–0.71) than among those with high knowledge. More providers with low knowledge reported ordering screening chest radiographs (aOR, 2.7; 95% CI, 1.4–5.0) within the past year. Conclusions: Referring provider knowledge of LCS guidelines is low and directly proportional to the ordering rate for LDCT in an at-risk US population. Strategies to advance evidence-based LCS should incorporate provider education and system-level interventions to address gaps in provider knowledge.

Correspondence: Jennifer A. Lewis, MD, MS, Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, 2220 Pierce Avenue, Nashville, TN 37232-6307. Email: jennifer.a.lewis@vanderbilt.edu

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