PCPs report 'important deficiencies' in managing abnormal cancer screening results

Limited support and barriers to care can make the process of following up on abnormal cancer screening findings difficult for primary care providers, according to researchers.

In a recent survey study, primary care providers reported “important deficiencies in managing the follow-up of all abnormal cancer screening test results.”

Notably, primary care providers viewed themselves as responsible for managing every abnormal screening result, despite the fact that other health care providers were involved in the process of notifying patients with abnormal results.

In light of the findings, Steven J. Atlas, MD, MPH, an associate professor of medicine at Harvard Medical School, and colleagues wrote in JAMA Network Open that there is a “need for comprehensive systems to promote timely follow-up of abnormal cancer screening results using a primary care-focused approach across the range of preventive cancer tests.”

“The multiple deficiencies reported by PCPs, including varying roles among clinicians, inadequate information technology and personnel support systems, and knowledge gaps, point to the need for multilevel interventions to support patients and PCPs, as well as integration efforts involving specialists,” they wrote. “If PCPs are going to bear responsibility for at least overseeing the follow-up of abnormal screens, then technology solutions should function similarly for the different screening test results.”

Atlas and colleagues conducted the survey study at three practice networks — Massachusetts General Hospital, Dartmouth Health and Brigham and Women’s Hospital — between February 2020 and October 2020, before taking part in a randomized clinical trial “to improve follow-up of abnormal cancer screening test results.”

Of the 275 respondents, 61.8% were female and 73.1% were general internists.

Fewer than half of providers said they were “satisfied with the process of managing abnormal screening results for any cancer type.” Still, most providers felt they were responsible for the management of abnormal scans no matter the cancer type (range, 63.6% [175 of 275] for breast cancer to 81.1% [223 of 275] for lung cancer; P < .001). Yet, Atlas and colleagues noted that “there were knowledge gaps in recommended follow-up intervals, especially for findings with longer follow-up windows that are more likely to require PCP intervention.”

Providers also said there was “limited support for following up on overdue abnormal cancer screening results,” and only a small number of providers reported feeling adequately supported by electronic systems and staff, according to the researchers.

The respondents said that support varied among cancer types: cervical and lung cancer processes were rated lowest, while breast cancer was highest. Further, providers reported differences in who they felt was supposed to notify a patient of abnormal screenings based on cancer type. For example, 65.1% of providers said the clinician performing a Pap test was responsible for notifying the patient, but 84.4% said the same for colonoscopies.

Aside from administrative difficulties, about half of the respondents said that, when it came to colorectal cancer, there were “major social barriers” to receiving care for any abnormal test results, and fewer than half were happy with the management process for abnormal cancer screening test results. Satisfaction was lowest for cervical (21.8% [59 of 271]) and lung cancer (22.4% [60 of 268]), the researchers wrote, and greatest for breast cancer (46.9% [127 of 271]).

In all, the survey participants “highlighted the complexities of tracking different abnormal cancer screening test results,” they wrote.

“Our findings are notable in showing that PCPs report deficiencies as being uniformly present but also variable in important ways among cancer screens. For example, follow-up of abnormal breast cancer screening results was viewed as being better than for other abnormal cancer screens and may reflect legislative efforts to ensure timely follow-up,” they wrote. “Prior efforts focused on improving follow-up for a single cancer test take a more specialist-oriented approach and may result in optimal systems that vary among the different screening tests.”

The results could be seen as support for “an approach whose goal is to develop tracking systems and protocols that are similar regardless of the specific cancer screening test rather than customizing to the specific test and result,” the researchers concluded.