Veteran and Lung Cancer Screening Coordinator Perspectives on Improving Adherence to Lung Cancer Screening

Background

Lung cancer screening (LCS) with low-dose CT scan has been shown to reduce mortality from lung cancer, the deadliest cancer killer. More than one-half of incident lung cancers detected in the National Lung Screening Trial were identified after the first year of screening, which highlights the importance of annual adherence to achieve mortality benefit from LCS. Although National Lung Screening Trial adherence across three rounds of screening was 95%, adherence in the community is lower and highly variable even within the same health system.

Research Question

What are patient and LCS coordinator perspectives on barriers and potential solutions to ensuring adherence to annual LCS?

Study Design and Methods

In this qualitative study, we conducted six veteran focus groups of 21 veterans who had undergone at least one LCS examination and individual interviews of eight LCS coordinators. Interviews and focus groups were transcribed and coded using qualitative content analysis. Codes were sorted into categories reflecting veteran perceptions, LCS ideas, observations, barriers, facilitators, preferences, recommendations, and LCS program issues. These codes were then analyzed and used to identify themes influencing adherence.

Results

The following four themes were identified from qualitative analysis: (1) direct communication about the repeat annual nature of screening was a driver for patient adherence, (2) patients recommended using other modalities including text messaging and mobile applications to improve adherence, (3) LCS coordinators reported a lack of emphasis and focus on adherence because of a lack of resources, and (4) the variability in program practices for bringing patients back every year and inability to measure adherence are barriers that need to be addressed.

Interpretation

Direct and multimodal communication may improve patient adherence to annual LCS, and system-level changes (eg, tracking dashboard and metrics) could assist LCS coordinators in addressing and focusing on LCS program adherence.