Do perceived barriers to lung cancer screening differ between attending physicians and residents?

Abstract

192 Background: In February 2015, legislation went into effect requiring Medicare to cover lung cancer (LC) screening with low dose computed tomography (LDCT) for high risk patients. Despite this, much debate and uncertainty exist among physicians about LC screening best practices. We aim to compare perceived barriers to LC screening between resident and attending physicians in Family and Internal Medicine, two departments selected for their high likelihood of seeing patients eligible for LC screening. Methods: Between February and July of 2015, a 23 question Qualtrics survey was conducted among physicians and residents at a large academic hospital to assess knowledge and beliefs of LC screening. In the Family and Internal Medicine departments, we surveyed 100 residents (30% response rate) and 86 attendings (49% response rate). Responses from the two departments were combined and stratified by attending or resident status. Results: Most respondents were White and non-Hispanic. Attendings were older (mean age 47, range 32-64) and mostly male (54%), while residents were younger (mean age 30, range 28-35) and mostly female (63%). The majority of attendings (62%) and residents (78%) agreed that limited time during patient visits requires presenting problems take priority over LC screening. Other barriers cited by both groups included cost to patients (74% attendings and 83% residents), potential for complications (53% and 70%), and too many false positives (67% and 73%). Over half of both groups agreed that inconsistent recommendations make it difficult to decide whether or not to screen for LC. In addition, the majority of both groups indicated that they were undecided about the benefit of LC screening for patients (43% attendings and 55% residents). No statistically significant differences were found. Conclusions: Regardless of resident or attending status, respondents identified inconsistent recommendations, time restrictions during visits, cost to patients, potential complications, and a high false positive rate as barriers to LC screening. Both groups reported being undecided about the utility of LC screening. These findings suggest a need for alternative strategies for future LC screening implementation.