Multipronged strategy significantly boosts lung cancer screening orders in primary care
A multipronged strategy can help to significantly boost lung cancer screening orders in primary care, according to new radiology research published Thursday.
Much has been made about poor adherence to low-dose CT screening recommendations, with only about 20% of eligible individuals imaged annually. Primary care providers are crucial to engaging patients and facilitating screening but may face myriad barriers such as knowledge gaps, lack of time, and difficulty collecting smoking history.
Experts at New York-based Weill Cornell Medicine aimed to address these challenges with an evidence-based, multicomponent strategy, according to research published in JACR. Dubbed “LungCheck,” the initiative is comprised of educational meetings, materials, clinician reminders, patient navigation and EHR modifications.
Researchers assessed the program’s impact across a 16-month pilot period and found promising results. LungCheck was associated with significantly increased low-dose CT ordering at two primary care settings, with high acceptability, appropriateness and feasibility.
“These findings suggest that a multicomponent strategy targeting provider behavior can substantially improve implementation of LCS in primary care while identifying opportunities for refinement to a multilevel strategy addressing patient, provider, and system level barriers before evaluation in a definitive trial,” lead author Lauren K. Groner, DO, MS, with Weill Cornell’s Department of Radiology at the time of the study, and colleagues wrote Oct. 22.
LungCheck, guided by the Behavior Change Wheel framework, has been described in previous literature, the authors note. It incorporates five components:
- Educational meetings covering lung cancer screening eligibility criteria, ordering procedures and shared decision-making.
- Educational materials including the LungCheck.org website with a pack-year calculator, screening eligibility checker and documentation templates.
- A formal implementation blueprint outlining step-by-step actions and responsible personnel.
- A patient navigator at each site for post-referral follow-up, appointment scheduling, insurance preauthorization, and care coordination.
- Site-specific electronic health record modifications including documentation templates and workflow enhancements.
The study compared a 16-month pilot period spanning 2024 to 2025 against another pre-pilot period (2022-2023) at two New York City primary care practices. These included a federally qualified health center practice in Queens, along with a hospital-based academic faculty group practice in Brooklyn. A total of nearly 6,000 patient-period observations were included in the study.
Among those with documented lung cancer screening eligibility, the odds of LDCT ordering were significantly higher during the pilot period at both the academic practice (odds ratio of 2.67) and FQHC (OR 4.53). A combined-site analysis—adjusted for various factors such as age, sex and race—confirmed higher odds of LDCT ordering during the pilot (OR 1.95). Among patients with an LDCT order, the completion rate was about 71% (10/14) before the pilot versus 36% (15/42) during the pilot at the academic practice. Meanwhile at the federally qualified health center site, completion rates were 43% (18/42) before the pilot compared to 39% (24/61) during the test phase.
Based on follow-up surveys, the strategy received high implementation acceptability, appropriateness and feasibility ratings among participating primary care providers and staff members. Post-pilot assessments also demonstrated high provider knowledge, confidence and perceived skills related to lung cancer screening. However, impediments to completing screening persisted, despite the intervention.
“Persistent barriers downstream of LDCT ordering are consistent with previous implementation studies identifying patient awareness, transportation, insurance, scheduling, and care coordination as major determinants of screening completion,” the authors noted. “[Previous research] reflects the increasing recognition that overcoming these barriers requires comprehensive patient navigation and other patient-directed interventions in addition to provider-directed interventions.”
Read more, including potential study limitations, in the Journal of the American College of Radiology.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.