Evaluations of Implementation at Early-Adopting Lung Cancer Screening Programs: Lessons Learned

Area of Science:

• Pulmonology
• Health Services Research
• Implementation Science

Background:

• Lung cancer screening (LCS) is recommended but its practical implementation is not well understood.
• Early adoption of LCS programs nationwide presents opportunities to study real-world challenges.
• Understanding implementation experiences is crucial for optimizing high-quality LCS.

Purpose of the Study:

• Evaluate the implementation experiences of early lung cancer screening programs.
• Characterize the barriers encountered during LCS program rollout.
• Identify effective strategies for successful LCS implementation.

Main Methods:

• Qualitative evaluation of LCS implementation across three Veterans Administration facilities.
• Conducted semistructured interviews with 29 key staff members.
• Utilized the Promoting Action on Research Implementation in Health Services (PARIHS) framework and grounded theory for analysis.

Main Results:

• LCS programs integrated most recommended components, with variations in patient selection, tobacco treatment, and quality audits.
• Key barriers included managing workload for pulmonary nodule evaluation and securing primary care provider "buy-in."
• Successful strategies involved nurse coordinators, multidisciplinary conferences, staged rollout, educational sessions, audit/feedback, and program champions.

Conclusions:

• Lung cancer screening implementation is complex, requiring multi-level coordination.
• Insights from early adopters can guide the design and implementation of future LCS programs.
• Addressing workload and primary care engagement are critical for successful LCS rollout.