“They Just Don’t Get Around to It”

Abstract

Background

Lung cancer screening (LCS) rates are low across the United States, with substantial disparities in availability and uptake. This trend is also reflected in the Veterans Affairs Healthcare System. We aimed to understand clinician perspectives on factors leading to low uptake and racial disparities in LCS.

Research Question

What are VA primary care providers' and LCS program staff's experiences with the LCS process and their perspectives on ways it could be improved to reduce disparities in LCS rates among Black veterans?

Study Design and Methods

Semistructured interviews were conducted at a Southeastern US Veterans Affairs Healthcare System with primary care providers and LCS program staff. Interview questions and notetaking templates were developed using the Consolidated Framework for Implementation Research. Rapid qualitative analysis was used to assess perspectives on barriers, facilitators, and contextual factors leading to low uptake and racial disparities in LCS to help inform future interventions.

Results

We interviewed 20 health care providers (17 primary care providers, 3 LCS program staff). Six emergent themes were derived from a combination of Consolidated Framework for Implementation Research domains and constructs. These included the following: (1) primary care providers’ complex experiences with the centralized LCS program, (2) LCS is 1 priority among many, (3) marked clinician variation in LCS shared decision-making and referral decisions, (4) racial biases and structural inequities, (5) limited clinician knowledge of patient-level screening facilitators, and (6) suggested program improvements. Themes underscored that improving the shared decision-making process and streamlining referral and scheduling are key areas for future interventions to improve LCS uptake.

Interpretation

Providers reported multiple barriers contributing to LCS disparities and suggested targeting interventions to improve the shared decision-making process and the transition from primary care to LCS visit. Future studies should evaluate such interventions and their impact on LCS uptake and equity.