Improving Lung Cancer Screening in Primary Care

The most common cause of mortality from malignancy is lung cancer. Unfortunately the overwhelming majority of lung cancers is detected in advanced stages, which is likely the driving factor for poor survival rates. There is evidence that early detection of lung cancer by screening high risk patients with annual low-dose CT scans can improve the survival rate by 20%. However, low dose CTs are not ordered by primary care physicians as routinely as other screening tests such as mammography. In the resident clinic at the Medical Faculty Associates at George Washington University Hospital, only 4.3% of physicians documented whether or not a patient met criteria for lung cancer screening. Documentation remained low despite both residents receiving information on lung cancer screening as well as forms distributed in clinic highlighting those meeting screening criteria. The initial thought was residents were not coached by attending physicians to screen for lung cancer in comparison to other screening tests during health maintenance exams. Preliminary surveys in January 2017 with attending physicians in primary care clinic indicated reasons for low screening rate may include lack of knowledge of guidelines, lack of habitual practice of new guidelines, obtaining insufficient smoking history to assess risk, overlooking high risk of former smokers, and concerns about insurance coverage. No physicians surveyed stated disagreement with lung cancer screening guidelines. Therefore, the major barrier to appropriate documentation may be increasing knowledge and emphasizing importance of lung cancer screening in primary care clinic. Our aim is to increase the rate of evidence-based documentation of candidacy for lung cancer screening by twofold over a six month period among Internal Medicine residents in the outpatient setting during the annual physical. Future strategies to reach this goal include education on appropriate screening steps and documentation, including lung cancer screening into health maintenance exam note macros, and reinforcement of guidelines by attending physicians