Veteran and Lung Cancer Screening Coordinator Perspectives on Improving Adherence to Lung Cancer Screening

Jonathan Angotti MD , Charlene Pope PhD , Nichole T. Tanner MD
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Abstract

Background

Lung cancer screening (LCS) with low-dose CT scan has been shown to reduce mortality from lung cancer, the deadliest cancer killer. More than one-half of incident lung cancers detected in the National Lung Screening Trial were identified after the first year of screening, which highlights the importance of annual adherence to achieve mortality benefit from LCS. Although National Lung Screening Trial adherence across three rounds of screening was 95%, adherence in the community is lower and highly variable even within the same health system.

Research Question

What are patient and LCS coordinator perspectives on barriers and potential solutions to ensuring adherence to annual LCS?

Study Design and Methods

In this qualitative study, we conducted six veteran focus groups of 21 veterans who had undergone at least one LCS examination and individual interviews of eight LCS coordinators. Interviews and focus groups were transcribed and coded using qualitative content analysis. Codes were sorted into categories reflecting veteran perceptions, LCS ideas, observations, barriers, facilitators, preferences, recommendations, and LCS program issues. These codes were then analyzed and used to identify themes influencing adherence.

Results

The following four themes were identified from qualitative analysis: (1) direct communication about the repeat annual nature of screening was a driver for patient adherence, (2) patients recommended using other modalities including text messaging and mobile applications to improve adherence, (3) LCS coordinators reported a lack of emphasis and focus on adherence because of a lack of resources, and (4) the variability in program practices for bringing patients back every year and inability to measure adherence are barriers that need to be addressed.

Interpretation

Direct and multimodal communication may improve patient adherence to annual LCS, and system-level changes (eg, tracking dashboard and metrics) could assist LCS coordinators in addressing and focusing on LCS program adherence.

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退伍军人和肺癌筛查协调员对提高肺癌筛查依从性的看法
低剂量CT扫描肺癌筛查(LCS)已被证明可以降低肺癌的死亡率,肺癌是最致命的癌症杀手。在国家肺部筛查试验中发现的肺癌病例中,有一半以上是在筛查的第一年之后发现的,这突出了每年坚持使用LCS以实现死亡率降低的重要性。尽管全国肺部筛查试验三轮筛查的依从性为95%,但即使在同一卫生系统内,社区的依从性也较低且差异很大。患者和LCS协调员对确保遵守年度LCS的障碍和潜在解决方案的看法是什么?研究设计与方法在本定性研究中,我们对21名至少接受过一次LCS检查的退伍军人进行了6个焦点小组的研究,并对8名LCS协调员进行了个别访谈。访谈和焦点小组使用定性内容分析进行转录和编码。代码被分为不同的类别,反映了老兵的看法、LCS的想法、观察、障碍、促进因素、偏好、建议和LCS项目问题。然后对这些代码进行分析并用于确定影响依从性的主题。结果定性分析确定了以下四个主题:(1)关于每年重复筛查性质的直接沟通是患者依从性的驱动因素;(2)患者建议使用其他方式,包括短信和移动应用程序来提高依从性;(3)由于缺乏资源,LCS协调员报告缺乏对依从性的重视和关注;(4)每年将患者带回来的项目实践的可变性和无法衡量依从性是需要解决的障碍。直接和多模式的沟通可以提高患者对年度LCS的依从性,系统层面的改变(例如,跟踪仪表板和指标)可以帮助LCS协调员解决和关注LCS计划的依从性。
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