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Community-Based Lung Cancer Screening Program Structure, Quality, and Barriers: The Struggle for Implementation.

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Lung cancer screening programs (LCSPs) show wide variation in structure and quality. Lack of resources and inconsistent implementation of recommended elements hinder effective lung cancer screening (LCS).

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Area of Science:

  • Public Health
  • Health Services Research
  • Oncology

Background:

  • Published recommendations exist for lung cancer screening programs (LCSPs).
  • Adoption and implementation of these recommendations require significant resources.
  • Variability in LCSP structure and quality may impact screening effectiveness.

Purpose of the Study:

  • To assess the presence of recommended structural and quality elements in LCSPs.
  • To identify barriers to performing lung cancer screening (LCS) within a healthcare network.

Main Methods:

  • Cross-sectional study conducted between June 2018 and July 2020.
  • Utilized two structured interviews: one for LCSP navigators and one for imaging administrators.
  • Assessed structural/quality elements of LCSPs and barriers to LCS implementation.

Main Results:

  • Most LCSPs (91%) were decentralized; few used standardized shared decision-making tools (14%) or multidisciplinary nodule review (59%).
  • Smoking cessation support was inconsistent, with 45% having standard procedures and only 23% employing Certified Tobacco Treatment Specialists.
  • Lack of resources (35%) was the primary barrier to implementing LCSPs, despite many sites having capacity for increased screening orders (61%).

Conclusions:

  • Significant variation exists in the structure, quality, and resource allocation across LCSPs.
  • Further research is needed to understand the impact of this variation on outcomes, costs, and patient experience.
  • The findings suggest a potential need for more stringent program quality control in lung cancer screening.