A Multicomponent Behavior Change and Implementation Strategy to Increase Lung Cancer Screening in Primary Care...

Area of Science:

• Implementation Science
• Behavioral Science
• Public Health

Background:

• National lung cancer screening (LCS) uptake remains low at approximately 16%, despite expanded eligibility under 2021 guidelines.
• Primary care settings face unique challenges in implementing guideline-concordant LCS.

Purpose of the Study:

• Identify barriers to LCS in primary care.
• Develop a theory-based strategy to improve LCS uptake.

Main Methods:

• A multiphase approach incorporating qualitative methods and established behavioral and implementation science frameworks.
• Utilized the Behavior Change Wheel, COM-B model, TDF, and ERIC to analyze barriers.

Main Results:

• Identified five key barrier themes: insurance pre-authorization, patient psychosocial factors, provider-patient communication, primary care practice culture, and patient follow-through.
• Barriers affect provider capability, opportunity, and motivation.
• Developed the LungCheck multicomponent strategy including education, an implementation blueprint, navigator, calculator, and EHR optimization.

Conclusions:

• A roadmap for using behavioral and implementation science to address LCS barriers and improve uptake.
• The radiologist-driven strategy has potential to increase LCS rates and serve as a model for other preventive initiatives.
• The multicomponent strategy will be evaluated in a pilot study.