Wong Lye-Yeng, Kapula Ntemena, Kang Augustine, Phadke Anuradha J, Schechtman Andrew D, Elliott Irmina A, Guenthart Brandon A, Liou Douglas Z, Backhus Leah M, Berry Mark F, Shrager Joseph B, Lui Natalie S
Department of Cardiothoracic Surgery, Stanford University Medical Center, Palo Alto, CA.
Department of Cardiothoracic Surgery, Stanford University Medical Center, Palo Alto, CA.
Clin Lung Cancer. 2025 Jan;26(1):39-44. doi: 10.1016/j.cllc.2024.10.002. Epub 2024 Oct 9.
Multidisciplinary lung cancer screening (LCS) programs that perform shared decision-making visits (SDMV) and follow up annual low dose computed tomography (LDCT) have been emerging. We hypothesize that primary care providers (PCPs) prefer to refer patients to LCS programs instead of facilitating the screening process themselves.
This is a mixed-methods, cross-sectional study in which an online survey was administered to PCPs between April 2023 and June 2023.
58 PCPs in the same hospital network participated in the study with a median age of 43 (34-51), predominance of women (77.6%), and clinicians of white and Asian race (44.8% and 48.3%). Respondents estimated that 26.1% (SD 32.4%) of their eligible patients participate in LCS screening. PCPs thought that an LCS program was equally convenient to performing screening themselves for identifying eligible patients and ordering LDCT. However, 63.8% of participants preferred an LCS program for performing SDMVs, 62.1% for ensuring annual follow-up on negative LDCTs, 70.7% for deciding next steps on positive LDCTs, and 60.4% for performing smoking cessation counseling. PCPs agreed that an LCS program saves time (69%), allows patients to receive specialty care (65.6%), addresses patient concerns (70.7%), ensures annual follow-up (77.6%), and manages abnormal findings (79.3%). However, they also expressed concerns about an additional visit for the patient (48.2%) and patient cost (46.5%).
Most PCPs believe that formal LCS programs have many benefits including providing specialized care and follow up, although there were concerns about patient time and cost.
开展共同决策问诊（SDMV）并对年度低剂量计算机断层扫描（LDCT）进行随访的多学科肺癌筛查（LCS）项目不断涌现。我们推测，初级保健提供者（PCP）更倾向于将患者转诊至LCS项目，而非自行推动筛查流程。
这是一项混合方法的横断面研究，于2023年4月至2023年6月对PCP进行了在线调查。
同一医院网络中的58名PCP参与了研究，中位年龄为43岁（34 - 51岁），女性占多数（77.6%），白人和亚洲种族的临床医生分别占44.8%和48.3%。受访者估计，其符合条件的患者中有26.1%（标准差32.4%）参与了LCS筛查。PCP认为，LCS项目在识别符合条件的患者并安排LDCT检查方面，与自行进行筛查同样便捷。然而，63.8%的参与者更倾向于LCS项目来进行共同决策问诊，62.1%倾向于由其确保对LDCT检查结果为阴性的患者进行年度随访，70.7%倾向于由其决定对LDCT检查结果为阳性的患者的下一步措施，60.4%倾向于由其提供戒烟咨询。PCP一致认为，LCS项目节省时间（69%），能让患者获得专科护理（65.6%），解决患者担忧（70.7%），确保年度随访（77.6%），并处理异常检查结果（79.3%）。然而，他们也对患者需要额外就诊（48.2%）和患者费用（46.5%）表示担忧。
大多数PCP认为，正式的LCS项目有诸多益处，包括提供专科护理和随访，尽管对患者的时间和费用存在担忧。
