A Multicomponent Behavior Change and Implementation Strategy to Increase Lung Cancer Screening in Primary Care Practices: The IBREATHE Study

Abstract

Objectives

Despite broader eligibility under the 2021 US Preventive Services Task Force guidelines, national lung cancer screening (LCS) uptake remains at around 16%. This radiologist-led study sought to identify LCS barriers in primary care settings and develop a theory-based behavior change and implementation strategy to improve screening rates in these settings.

Methods

A multiphase approach was used, including qualitative methods and frameworks (ie, Behavior Change Wheel; Capability, Opportunity, and Motivation of Behavior model; Theoretical Domains Framework; and Expert Recommendations for Implementing Change glossary) to understand and address LCS barriers.

Results

LCS barriers are represented by five major themes: (1) insurance pre-authorization; (2) patients’ cognitive and psychosocial barriers; (3) provider-patient knowledge and communication barriers; (4) the culture of a busy primary care practice; and (5) the test is ordered, patients do not follow through. Barriers impact primary care providers’ capability, opportunity, and motivation to implement guideline-concordant LCS into practice. The final multicomponent strategy (LungCheck) addressing these barriers includes educational meetings and materials, an implementation blueprint, a LCS navigator, a practical pack-year calculator, and electronic health records optimization.

Conclusions

We provide a road map for using behavioral and implementation science to understand LCS barriers and design an evidence-based, theory-informed multicomponent strategy to improve LCS uptake. Our radiologist-driven strategy addresses LCS barriers in primary care, has the potential to increase screening rates, and can serve as a model for implementing similar preventive health initiatives in other settings. The multicomponent strategy will be evaluated in a pilot study with two primary care practice models.