Kaiser Permanente Washington Health Research Institute, Seattle, WA.
Perm J. 2021 Jun 2;25:20.295. doi: 10.7812/TPP/20.295.
Limited evidence-based implementation strategies exist for maintaining lung cancer screening. We evaluated the Lung Cancer Screening Program at Kaiser Permanente Washington (KPWA) to develop multilevel interventions to improve screening adherence.
We conducted a concurrent mixed-methods study 1) to measure adherence to repeat screening with low-dose computed tomography (LDCT); 2) to interview KPWA stakeholders to understand the Lung Cancer Screening Program; and 3) to conduct codesign workshops with KPWA members and researchers. We used descriptive statistics to describe adherence, and rapid qualitative data analysis for stakeholder interviews and workshops.
Between 2015 and 2019, 2089 KPWA members had initial LDCT scans with negative, benign or short-interval follow-up results. Among those with sufficient follow-up, the proportion with on-time repeat screening after a negative LDCT was 26.4% after the initial scan, and increased to 43.1% on subsequent scans. Opportunities for health-care system improvement included clarification of clinical roles and responsibilities, care coordination across providers, ongoing training in lung cancer screening, and revising electronic health record tools. From patient perspectives, facilitators to repeat screening were making screening personalized and convenient; offering consistent messages and reminders in different modes; increasing patient knowledge about benefits, harms, and expectations of LDCT; and providing nonfinancial and financial incentives for adherence. From a storyboard exercise, we identified 10 design features for lung cancer screening interventions, including versatility of communication, social support, and knowledge.
We identified clear gaps in adherence to lung cancer screenings, organizational and clinical barriers to care, and design features for patient-centered interventions to improve lung cancer screening in US settings.
目前针对维持肺癌筛查的循证实施策略有限。我们评估了 Kaiser Permanente Washington（KPWA）的肺癌筛查计划，以制定多层次干预措施来提高筛查的依从性。
我们同时进行了一项混合方法研究，1）测量低剂量计算机断层扫描（LDCT）重复筛查的依从性；2）对 KPWA 利益相关者进行访谈，以了解肺癌筛查计划；3）与 KPWA 成员和研究人员进行共同设计研讨会。我们使用描述性统计来描述依从性，并对利益相关者访谈和研讨会进行快速定性数据分析。
在 2015 年至 2019 年期间，2089 名 KPWA 成员进行了初始 LDCT 扫描，结果为阴性、良性或短期随访。在有足够随访的人群中，初始 LDCT 扫描阴性后按时进行重复筛查的比例为首次扫描后的 26.4%，随后扫描时增加到 43.1%。改善医疗保健系统的机会包括明确临床角色和责任、协调提供者之间的护理、持续进行肺癌筛查培训以及修改电子健康记录工具。从患者角度来看，促进重复筛查的因素包括使筛查个性化和便利化；以不同模式提供一致的信息和提醒；提高患者对 LDCT 的益处、危害和预期的了解；以及提供非财务和财务激励措施以提高依从性。从故事板练习中，我们确定了 10 个肺癌筛查干预措施的设计特征，包括沟通的多功能性、社会支持和知识。
我们确定了肺癌筛查的依从性存在明显差距，以及对护理的组织和临床障碍，以及针对以患者为中心的干预措施的设计特征，以改善美国的肺癌筛查。
