Study identifies factors behind guideline-discordant use of lung cancer screening
Interviews with 31 primary care physicians suggested that knowledge gaps about the life expectancy threshold at which lung cancer screening's value becomes limited may contribute to their decisions to recommend screening to patients who may not benefit.
Knowledge gaps and attitudes may drive primary care physicians' decisions to offer lung cancer screening to patients with limited life expectancy, according to results of a qualitative study.
To understand the barriers primary care physicians face when it comes to incorporating life expectancy into lung cancer screening decisions, researchers carried out semistructured phone interviews with 31 physicians, 61.3% men, from six Veterans Health Administration facilities across the Northeast, Midwest, and South. Results were published by the Journal of General Internal Medicine on March 8.
Results showed physicians used a threshold of a six-month to two-year life expectancy to decide lung cancer screening was of limited value, as opposed to five years as recommended by guidelines. In addition, physicians identified discomfort estimating life expectancy and fear of missing cancer as barriers to avoiding low-value screening.
Just two physicians reported they felt "very comfortable" with estimating life expectancy. Prioritizing quality of life, patient values, the clinician-patient relationship, and family support were also cited as barriers to incorporating life expectancy in physicians' decisions. Physicians were receptive to a decision support tool that would inform and communicate the appropriateness of lung cancer screening decisions as way to improve guideline concordance, if it were easy to use and integrated into clinical workflows.
All included sites had a formal lung cancer screening program and the results may not be generalizable to other practices, the study authors cautioned.
"Now is the time to overcome barriers to guideline adherence; integration of point-of-care tools that support [primary care providers] in incorporating life expectancy into [lung cancer screening] patient selection and shared decision-making may be a promising solution," the authors concluded.