Lung cancer screening for high-risk patients: A quality improvement initiative to improve guideline adherence in real-world primary care practices.

Abstract

e22527 Background: Lung cancer remains the leading cause of cancer-related deaths in the US, but early detection through screening offers a high cure rate. Despite USPTF guidelines recommending low-dose computed tomography (LDCT) for adults aged 50-80 years with a 20 pack-year smoking history, fewer than 15% of eligible patients are screened. This quality improvement (QI) initiative aimed to identify barriers and implement interventions to improve screening and referrals in primary care clinics. Methods: In 2024, 74 healthcare providers (HCPs) from six US clinics completed baseline surveys on screening practices. Based on identified gaps, a point-of-care (POC) resource was developed to streamline patient identification, referrals, and follow-up. HCPs (n = 49) then participated in two cross-clinic educational sessions addressing individual and systemic barriers, and developed and implemented clinic-specific action plans, including integrating the POC resource into workflows. Follow-up surveys assessed practice changes and action plan implementation. Results: Baseline surveys revealed that only 41% of HCPs identified the correct guideline-recommended population for screening, and 37% were unaware LDCT—not chest X-ray—is the recommended modality. Providers reported that just 41% of high-risk patients were referred for LDCT. Barriers to screening included insurance concerns, patient fear of diagnosis, and HCP knowledge gaps about eligibility and LDCT benefits and risks. Although shared decision-making (SDM) can alleviate patient fears, only 45% of HCPs recognized SDM as a critical first step, and fewer than 50% expressed high confidence in conducting SDM. Team-based action plans focused on HCP education, new protocols for identifying high-risk patients, assigning care coordinators, emphasizing SDM, and integrating the POC tool into practice. In follow-up surveys (n = 35), 46% of HCPs reported using the tool regularly during patient consultations, and 34% integrated it into workflows. Additionally, 89% of providers reported their team developed/improved protocols to identify high-risk patients, 86% increased use of/referral for LDCT, and 83% reported increased patient adherence to screening. Conclusions: Lung cancer screening remains underutilized due to knowledge gaps, logistical barriers, and patient concerns. This QI initiative provides strategies to enhance guideline-concordant lung cancer screening practices, including streamlined workflows, point-of-care resources, and a stronger focus on effective shared decision-making (SDM). By empowering providers and patients to engage in informed discussions, these efforts aim to boost screening rates and improve patient outcomes.