Documentation of Smoking History and Adherence to the USPSTF Recommendation for Lung Cancer Screening: A Retrospective Chart Review

Purpose: The purpose of this project was to evaluate provider compliance with documentation of smoking history and, if criteria met, referral for lung cancer screening as recommended by the United States Preventive Services Task Force in 2013. Methods: A retrospective chart review was conducted using an electronic medical record (EMR) at a large, rural community family practice clinic. Patients meeting inclusion criteria of having a smoking history (current or past) of 30 pack years, aged 55 to 80 years, and no history of lung cancer diagnosis were included for randomization. One hundred patients were selected from 300 randomized charts; five were excluded due to not meeting criteria. The number of patients with completed smoking history and appropriate referral for lung cancer screening were calculated. Descriptive statistics were used to analyze the data. Results: From the electronic medical records reviewed (n = 95), only 48.4% (n = 46) of patients had pack years completed. Among all patients, lung cancer screening criteria eligibility were met in 44.2% (n = 42) of the patients while 51.6% (n = 49) were unknown due to incompleteness of their smoking history. Among patients who had documentation of pack years completed (n = 46), 42 (91%) were eligible for screening. None of these patients had a computed tomography scan (CT) ordered or completed. Only one (1.1%) patient of the 95 reviewed in this practice was referred for lung cancer screening. This patient did not have smoking history completed nor did this patient follow up to complete the screen. Conclusion: Without completion of patients’ smoking history, including length of smoking and packs per day, proper risk assessment for lung cancer cannot be completed. Risk assessment is key to determining eligibility for referral thus prompting providers to initiate referrals for screening. Noting a 20% reduction in death due to lung cancer with low dose CT, 19 patients from this sample of 95 could face death related to lung cancer due to lack of screening. Recognizing that only 1.1% (n = 1) of the reviewed patients was recommended for screening, it is imperative to educate providers on assessing patients for eligibility, providing face to face counseling, making referrals, and evaluating the effectiveness of the EMR screening tool. Implementing such measures can enhance detection of early stages of lung cancer and improve survival rates