P41.02 Implementation Barriers In US-based Lung Cancer Screening Programs

Abstract

Both the National Lung Screening Trial and the Dutch-Belgian Randomized Lung Cancer Screening Trial (NELSON) demonstrate that screening by low-dose computed tomography (LDCT) leads to a reduction in lung cancer mortality underscoring the importance of implementing effective LDCT screening programs for those at risk. To better understand implementation barriers that programs face, the GO2 Foundation for Lung Cancer’s Screening Centers of Excellence (SCOE) network was surveyed to assess barriers in US-based screening programs related to patients, workflow and reimbursement. 100 SCOE network members, representing 87753 patients screened, participated in the survey. The survey was conducted online, focused on collecting data from calendar year 2018, and was analyzed by a market research firm ZoomRx. The survey assessed program structure, implementation barriers, capacity, screening rates and workflow. The survey was designed to baseline participants by collecting both quantitative and qualitative data and will be deployed annually to allow for longitudinal analysis. Data analysis allows the comparison of different groups such as academic v community, size of program and age of program. Of the 100 SCOE participants, 22 identified as academic-based programs, 61 as community-based, and the remaining as having other program structures (such as being a stand-alone imaging center). When asked what types of barriers were most challenging to them, the top category reported by academic programs was Patient-Volume/Patient-related barriers (reported by 55% of programs) and the top category reported by community programs was Operational/workflow barriers/lack of institutional buy-in (reported by 36% of programs). In addition to indicating the general categories of barriers that presented the most challenges to them, SCOEs were also asked to indicate what specific barriers they faced. 68% of academic programs indicated patients not returning for annual screenings and 50% reported patients not returning for interval follow up screenings. 46% of academic centers reported experiencing barriers in each of the following three areas: ordering/documenting eligibility, patient tracking/data management, and insurance coding/claims difficulties. When community programs were asked about specific barriers, 64% reported staffing limitations, 61% reported patients not returning for annual screenings, and 56% reported lack of support from referring providers. The impact of barriers differs between center types with academic centers finding patient and volume related issues more challenging in 2018 while community centers found workflow and institutional issues more challenging. In terms of what specific barriers were encountered, lack of patient adherence to annual follow up screening is frequently encountered by all types of programs. However, a majority of community-based programs reported issues with staffing or lack of support from referring providers in direct contrast to academic based centers. This suggests that initiatives to improve screening implementation must address both common barriers and program-type specific issues. The SCOE program represents a unique opportunity to study screening implementation at scale and across settings and is an ideal platform for implementing potential solutions to address barriers.