Implementing lung cancer screening in primary care: needs assessment and implementation strategy design

Area of Science:

• Implementation Science
• Primary Care Medicine
• Public Health

Background:

• Lung cancer screening using low-dose computed tomography (CT) has the potential to significantly reduce mortality.
• Effective implementation of lung cancer screening programs in primary care settings remains complex and requires targeted strategies.
• Integrating decision aids into electronic health records (EHRs) presents an opportunity to streamline screening processes.

Purpose of the Study:

• To explore the implementation of lung cancer screening within primary care.
• To design theory-based implementation strategies for a decision aid integrated into the EHR.
• To identify key task behaviors and behavioral determinants influencing lung cancer screening in primary care.

Main Methods:

• A two-phase study involving qualitative analysis through semi-structured interviews with primary care physicians.
• Elicitation of key task behaviors (e.g., ordering low-dose CT) and behavioral determinants (e.g., social influence).
• Design of implementation strategies based on hypothesized mechanisms of change and identified barriers.

Main Results:

• Three key task behaviors and four behavioral determinants related to lung cancer screening were identified from 14 interviews.
• Implementation strategies were developed to target provider self-efficacy, performance expectancy, social influence, and facilitators for decision aid use.
• Strategies aimed to address multiple levels of influence to enhance screening uptake.

Conclusions:

• This research provides theoretical insights into the behavioral determinants of lung cancer screening task behaviors.
• Novel implementation strategies were designed based on causal pathways, offering a replicable model for other institutions.
• Further research is necessary to evaluate the effectiveness and contextual applicability of these designed strategies.