Efforts to increase the application of low-dose computed tomography (LDCT): A resident-led strategy to improve lung cancer screening in an urban primary care clinic.

Abstract

132 Background: Lung cancer carries the highest mortality rate of all malignancies, implicated in approximately 20% of cancer-related deaths in the United States. The 2011 National Lung Screening Trial (NLST) established a 20% reduction in lung cancer-associated mortality associated with annual LDCT screening in high-risk populations compared to screening chest radiography. In 2013 the United States Preventative Services Task Force (USPSTF) adopted this approach into their recommendations, with a subsequent update in 2021 establishing a recommended annual LDCT screening for those at high risk. There remains a concerning lack of access to PCP-initiated LDCT screening in medically underserved (e.g., urban, rural) areas, translating to relatively low rates of early lung cancer detection. Methods: Any patient meeting the 2021 USPSTF criteria (at least 20-pack-year history of tobacco use, who still smoke or have quit within the past 15 years) was deemed eligible. Excluded were those meeting these criteria and any patient who had received LDCT within the past 12 months. The pre-intervention stage of this study included a 15-week data collection of chart review to establish baseline rates. The intervention involved an educational flyer detailing the guidelines for lung cancer screening, placed in each clinic exam room to promote patient self-assessment of eligibility. Results: In the 15-week control group (i.e., pre-intervention), 177 patients were eligible for LDCT screening, with 65 successful LDCT orders and 112 not ordered (36.7% screened appropriately) and 27 (41.5%) LDCT orders completed. Through the 15 weeks of post-intervention data, 193 patients were eligible for LDCT screening, with 99 orders placed and 94 not (51.3% screened appropriately), and 42 (42.4%) of these LDCT orders were completed. Conclusions: The initial goal set for this project was a 50% lung cancer screening rate among eligible patients, with at least 50% of those LDCT orders performed by the patient. There was a remarkable improvement in LDCT ordering rates; however, the primary goal of these ordering improvement rates was to translate them into a higher percentage of patients completing these orders. Despite the increase in LDCT orders, the percentage completed stagnated (41.5% pre-intervention, 42.4% post-intervention). It was essential to our team that the interventions remain cost-effective. We did achieve this using printed flyers, allowing for patient-initiated involvement in the process. Using these interventions as a template, a clinic in any setting may benefit their LDCT ordering rates. However, these measures alone will not improve the percentage of patients completing the LDCT orders. As our project continues, we plan to modify the intervention to reflect constructive feedback from the resident physicians and patients involved.