Assessing Providers' knowledge about and barriers to lung cancer screening

Low dose computed tomography (LDCT) for lung cancer screening (LCS) is underutilized despite its demonstrated mortality benefit compared to chest radiography. Our study aimed to assess knowledge about LCS and barriers to ordering LDCT from the viewpoint of primary care and pulmonology providers in academic and community settings.

Providers of various specialties (pulmonology, family medicine, internal medicine, geriatric medicine) who were practicing in Southern California and provided care to patients aged 50 or more were asked to complete a 10-minute survey to assess knowledge about LCS criteria, and barriers to the use of LDCT scan screening. Knowledge scores were calculated for each respondent based on their responses to 9 questions based on Centers for Medicare and Medicaid Services eligibility criteria with a total score range from 0 to 9 points.

32 eligible providers completed the survey, of which none correctly identified all CMS eligibility criteria. Average knowledge score was 6.6 ± 1.1 and did not significantly differ based on practice setting, training level, or years of practice. Common barriers to utilization of LDCT included inaccurate smoking history in the medical record (56.2 %), failure of the medical record to notify providers of eligible patients (43.7 %), and concerns about financial cost of downstream tests after a positive scan (38.7 %).

Suboptimal provider knowledge of LDCT criteria may contribute to LCS underutilization. Improvement of educational resources for providers and augmentation of EMR smart tools to update documented smoking histories and notify providers of eligible patients may improve the rate of LCS.