Lack of primary care clinician a barrier to lung cancer screening
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Lack of a primary care provider may hinder an individual’s ability to undergo lung cancer screening, according to results of a quality improvement study.
Researchers called hospitals via their main telephone numbers to ask about lung cancer screening. During these calls, researchers simulated individuals who wanted information about screening but did not have a primary care clinician.
Investigators initially conducted a directed sampling of 527 U.S. hospitals, and then they conducted a random sampling of 500 hospitals.
Of the 527 hospitals initially contacted, 51 (9.2%) facilitated any aspect of a lung cancer screening process. Not having a primary care clinician’s order represented the most common reason for failure of these calls to secure screening (317 calls; 60.2%). Subsequent calls made to the random subset of 500 hospitals yielded similar results.
“For every 300 people who undergo lung cancer screening, a life will be saved. However, less than 10% of people eligible for lung cancer screening participate, resulting in tens of thousands of preventable deaths every year in the United States,” Daniel J. Boffa, MD, MBA, professor and chief of thoracic surgery at Yale School of Medicine, told Healio. “We have been trying to figure out why so few people participate in lung cancer screening. The lack of a primary care clinician is not the only issue, but it could represent a major opportunity to reduce lung cancer deaths in the United States.”
Healio spoke with Boffa about this gap in care and what strategies might be used to better facilitate lung cancer screening.
Healio: Why did you decide to conduct this study?
Boffa: Cancer organizations have increasingly tried to motivate current or former tobacco smokers to start the lung cancer screening process by asking their primary care clinician about the subject. We realized that this approach could be challenging for the 100 million people who don’t have a primary care clinician. People without a primary care clinician are advised to call hospitals directly for cancer screening, but we were not sure if hospitals were prepared to handle these calls.
Healio: How did you conduct this study?
Boffa: We initially called 500 hospitals as a quality assurance study, making sure to call at least eight hospitals per state, and to make sure we included a good number of hospitals that were accredited by the Commission on Cancer, a large cancer organization that works to improve the quality of cancer treatment. This demonstrated a concerning signal, so we called another 500 hospitals chosen at random to confirm the findings.
Healio: What did you find?
Boffa: Less than 10% of hospitals we called were able to connect us to any part of the lung cancer screening process. The most common reason calls failed was lack of a primary care clinician. Other reasons included telephone trees that did not lead to a person or led to a voicemail that was not returned.
Healio: Did anything surprise you?
Boffa: We were quite surprised that so few hospitals were able to connect to screening because of how effective lung cancer screening can be at preventing death due to lung cancer.
Healio: What are the potential implications of this study?
Boffa: We hope to create more awareness of the challenges faced by patients who lack a primary care clinician but are eligible for and interested in lung cancer screening. Although this study focused on lung cancer, it is likely that additional opportunities exist to increase screening for other types of cancer among people who lack a primary care clinician.
Healio: What steps should be taken to address this gap in care?
Boffa: We are hopeful this study will support ongoing efforts to increase access to primary care. At the same time, there are opportunities to make it easier for patients lacking a primary care clinician to be screened for lung cancer, potentially by having patients self -manage some of the steps after lung cancer screening, such as scheduling follow-up tests through their online health portal.
Reference:
For more information:
Daniel J. Boffa, MD, MBA, can be reached at daniel.boffa@yale.edu.
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