P3.10-003 Assessing and Addressing Knowledge Gaps to Improve Lung Cancer Screening Rates

Abstract

The National Lung Screening Trial showed that annual screening with low-dose computed tomography (LDCT) in high-risk patients reduced lung cancer mortality by 20%. The United States Preventative Services Task Force (USPSTF) now recommends lung cancer screening (LCS) for high-risk individuals. However, only about 10% of eligible individuals are referred for LDCT possibly in part due to a lack of familiarity among primary care physicians with LCS guidelines. In this analysis, we sought to obtain a baseline acumen of providers’ knowledge and awareness about LCS and develop a series of interventions including embedding USPSTF criteria into electronic medical record (EMR) ordering to educate providers and facilitate more effective use of LCS for high-risk patients. A Lung Cancer Screening Program was started in 2015 led by a nurse practitioner. Internal medicine residents at the University of Illinois – Chicago (UIC) General Medicine Clinic (GMC) were surveyed using paper questionnaires. The survey included 6 questions on USPSTF LCS guidelines. Next, educational efforts were addressed through a lecture, email reminders, and informational clinic flyers. Finally the EMR order set was updated to include USPSTF criteria directed ordering. The number of appropriately ordered screens through GMC was tracked monthly. A post-intervention survey was distributed to evaluate if providers’ knowledge was improved by these interventions. Fifty-three IM residents were surveyed regarding LCS guidelines appropriate for LDCT screening. Of the respondents, 87% knew the correct test for screening was LDCT, 66% knew only smokers with ≥30 pack year history were eligible, 45% knew the minimum age criteria (55 years-old), 28% knew the maximum age (80 years-old), 42% knew interval to re-order screening for a negative test (1 year), and 38% knew the maximum time since quitting (15 years). Following the initial interventions there was an increase in the rate of appropriately ordered LDCT screening tests ordered through GMC clinic (from 6.8 per month [May 2016 to September 2016] to 10.8 per month [Oct. 2016 to Apr. 2017]). Post-intervention knowledge assessment is underway and will be presented. Although LCS is recommended by USPSTF, there are gaps in knowledge about eligibility criteria among internal medicine residents. We present data that suggests using educational interventions and changes in EMR to increase awareness and knowledge is associated with an increase in appropriate usage of LDCTs for LCS. Ultimately, we plan to broaden these interventions to additional primary care clinics (e.g., Family Medicine, Pulmonary) to improve proper use of LCS at our institution.