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

Despite broader eligibility under the 2021 US Preventive Services Task Force guidelines, national lung cancer screening (LCS) uptake remains at around 16%. This radiologist-led study sought to identify LCS barriers in primary care settings and develop a theory-based behavior change and implementation strategy to improve screening rates in these settings.

A multiphase approach was used, including qualitative methods and frameworks (ie, Behavior Change Wheel; Capability, Opportunity, and Motivation of Behavior model; Theoretical Domains Framework; and Expert Recommendations for Implementing Change glossary) to understand and address LCS barriers.

LCS barriers are represented by five major themes: (1) insurance pre-authorization; (2) patients' cognitive and psychosocial barriers; (3) provider-patient knowledge and communication barriers; (4) the culture of a busy primary care practice; and (5) the test is ordered, patients do not follow through. Barriers impact primary care providers' capability, opportunity, and motivation to implement guideline-concordant LCS into practice. The final multicomponent strategy (LungCheck) addressing these barriers includes educational meetings and materials, an implementation blueprint, a LCS navigator, a practical pack-year calculator, and electronic health records optimization.

We provide a road map for using behavioral and implementation science to understand LCS barriers and design an evidence-based, theory-informed multicomponent strategy to improve LCS uptake. Our radiologist-driven strategy addresses LCS barriers in primary care, has the potential to increase screening rates, and can serve as a model for implementing similar preventive health initiatives in other settings. The multicomponent strategy will be evaluated in a pilot study with two primary care practice models.