P1.03-053 The Effect of Primary Care Physician Knowledge of Lung Cancer Screening Guidelines on Perceptions and Utilization of Low Dose CT

Abstract

Lung cancer screening with low-dose computed tomography (LDCT) is recommended by the U.S. Preventive Services Task Force (USPSTF) in high-risk patients, but a minority of eligible people is screened. It is unknown whether knowledge of USPSTF recommendations among primary care physicians (PCP) impacts perceived benefits and utilization of LDCT. As we previously reported, a randomly selected sample of 1384 primary care physicians in Los Angeles County was surveyed between January and October 2015, using surveys sent by mail, fax, and email. The response rate was 18%. Training background, years in practice, practice type, and respondent demographics were collected. We analyzed results based on the response to a question on whether the USPSTF recommends the use of LDCT to screen high-risk individuals for lung cancer. One hundred seventeen (47%) PCPs responded that the USPSTF recommends LDCT for LCS. Of PCPs who were aware of USPSTF recommendations, 94% responded that CT was somewhat or very effective at reducing lung cancer mortality among individuals meeting eligibility criteria, compared with 79% who were unaware (p=0.013). 27% of those aware of the recommendations thought chest X-ray (CXR) was effective at reducing lung cancer mortality compared with 62% of unaware PCPs (p=0.001). A similar number of PCPs in each group ordered CXR for screening over the past 12 months, but a larger proportion of PCPs aware of guidelines ordered LDCT (69% vs 36%, p <0.001) and initiated a discussion on screening (84% vs 59%, p<0.001) over the past 12 month. 14% of PCPs aware of guidelines reported that benefits of LCS were not clear to them compared with 43% of those unaware of guidelines (p<0.001). Both groups of PCPs reported similar scores when questioned on other barriers to screening such as insurance coverage, risks of LCS, and cost to society. There were no differences between groups by practice size, training background, years in practice, or PCP demographics. Awareness of USPSTF recommendations for lung cancer screening is associated with the perception of benefit of LDCT and with increased utilization of LDCT for screening. Educational interventions for PCPs may improve adherence with LCS recommendations.