TY - JOUR
T1 - A national survey of pulmonologists' views on low-dose computed tomography screening for lung cancer
AU - Iaccarino, Jonathan M.
AU - Clark, Jack
AU - Bolton, Rendelle
AU - Kinsinger, Linda
AU - Kelley, Michael
AU - Slatore, Christopher G.
AU - Au, David H.
AU - Wiener, Renda Soylemez
N1 - Publisher Copyright:
Copyright © 2015 by the American Thoracic Society.
PY - 2015/11
Y1 - 2015/11
N2 - Rationale: Multiple guidelines now recommend low-dose computed tomography (LDCT) screening for lung cancer. Given their central role in the planning of LDCT screening programs, pulmonologists' beliefs about LDCT screening will affect the safety, cost-effectiveness, and success of LDCT screening implementation. Objectives: To assess pulmonologists' propensity to offer lung cancer screening and their perceptions about LDCT screening. Methods:We performed a national web-based survey, administered July 2013 to February 2014, among all staff pulmonologists active in Veterans Health Administration pulmonary clinics. The primary outcome was screening propensity (on the basis of responses to clinical vignettes) in relation to guidelines. Using bivariate and multinomial logistic regression, we assessed how perceptions of the evidence, trade-offs, and barriers to implementationofLDCTscreening programs affected propensity to screen. Measurements and Main Results: Of 573 eligible pulmonologists e-mailed, 286 (49.9%) participated. Approximately one-half (52.4%) had a propensity for guideline-concordant screening, 22.7% for overscreening, and 24.9% for underscreening. In bivariate analyses, guideline concordance was associatedwith acceptance of trial evidence, guidelines, and the efficacy of screening. In multivariable models, underscreeners were more likely to cite the potential harms of screening (e.g., false-positive findings, radiation exposure, incidental findings, unfavorable cost-benefit ratio), as influential factors (relative risk, 3.9; 95% confidence interval, 1.5-9.67) and were less influenced by trial evidence and guidelines (relative risk, 0.06; 95%confidence interval, 0.02-0.2), as comparedwith guideline-concordant screeners. Local resource availability did not significantly affect screening propensity, but insufficient infrastructure and personnel were commonly perceived barriers to implementation. Conclusions: Pulmonologists have varied perceptions of the evidence and trade-offs of LDCT screening, leading to the potential for over-and underscreening. To minimize potential harms as LDCT screening is widely implemented, physicians must understand which patients are appropriate candidates and engage those patients in a shared decisionmaking process regarding the trade-offs of LDCT screening.
AB - Rationale: Multiple guidelines now recommend low-dose computed tomography (LDCT) screening for lung cancer. Given their central role in the planning of LDCT screening programs, pulmonologists' beliefs about LDCT screening will affect the safety, cost-effectiveness, and success of LDCT screening implementation. Objectives: To assess pulmonologists' propensity to offer lung cancer screening and their perceptions about LDCT screening. Methods:We performed a national web-based survey, administered July 2013 to February 2014, among all staff pulmonologists active in Veterans Health Administration pulmonary clinics. The primary outcome was screening propensity (on the basis of responses to clinical vignettes) in relation to guidelines. Using bivariate and multinomial logistic regression, we assessed how perceptions of the evidence, trade-offs, and barriers to implementationofLDCTscreening programs affected propensity to screen. Measurements and Main Results: Of 573 eligible pulmonologists e-mailed, 286 (49.9%) participated. Approximately one-half (52.4%) had a propensity for guideline-concordant screening, 22.7% for overscreening, and 24.9% for underscreening. In bivariate analyses, guideline concordance was associatedwith acceptance of trial evidence, guidelines, and the efficacy of screening. In multivariable models, underscreeners were more likely to cite the potential harms of screening (e.g., false-positive findings, radiation exposure, incidental findings, unfavorable cost-benefit ratio), as influential factors (relative risk, 3.9; 95% confidence interval, 1.5-9.67) and were less influenced by trial evidence and guidelines (relative risk, 0.06; 95%confidence interval, 0.02-0.2), as comparedwith guideline-concordant screeners. Local resource availability did not significantly affect screening propensity, but insufficient infrastructure and personnel were commonly perceived barriers to implementation. Conclusions: Pulmonologists have varied perceptions of the evidence and trade-offs of LDCT screening, leading to the potential for over-and underscreening. To minimize potential harms as LDCT screening is widely implemented, physicians must understand which patients are appropriate candidates and engage those patients in a shared decisionmaking process regarding the trade-offs of LDCT screening.
KW - Early detection of cancer
KW - Health care surveys
KW - Lung neoplasms
KW - Physicians
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U2 - 10.1513/AnnalsATS.201507-467OC
DO - 10.1513/AnnalsATS.201507-467OC
M3 - Review article
C2 - 26368003
AN - SCOPUS:84946734202
SN - 2325-6621
VL - 12
SP - 1667
EP - 1675
JO - Annals of the American Thoracic Society
JF - Annals of the American Thoracic Society
IS - 11
ER -