Provider and Patient Perspectives to Improve Lung Cancer Screening with Low-Dose Computed Tomography 5 years after Medicare Coverage: A Qualitative Study

Lung cancer remains the leading cause of cancer-related deaths for both men and women in the U.S. despite the availability of preventive cancer screening for high-risk smokers. This qualitative study of patients and providers from a large ambulatory healthcare system in northern California explored perceptions of lung cancer screening with low-dose computed tomography (LCS-LDCT) 5 years after Medicare coverage to identify modifiable targets to improve the implementation of LCS-LDCT. Between 2019 and 2020, interviews were conducted with 10 primary care physicians and 30 patients from three groups (completed LCS-LDCT, scan ordered but not completed, eligible but no order) using semi-structured interview guides. Providers and patients expressed that they were both aware and supportive of LCS-LDCT but reported little to no shared decision making nor use of a decision aid despite being Medicare requirements. Respondents suggested improvements to LCS-LDCT including incorporating a nurse navigator into the process to ease the burden on providers and provide additional education and counselling about screening and support for tobacco cessation to patients. Given recently expanded guidelines from the U.S. Preventive Service Task Force for LCS-LDCT screening, and the expectation that these new guidelines may be covered by Medicare in the near future, it is important for healthcare systems to understand provider and patient perceptions to further improve the implementation of LCS-LDCT to ultimately reduce lung cancer mortality.