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A National Survey of Pulmonologists' Views on Low-Dose Computed Tomography Screening for Lung Cancer.

Publication ,  Journal Article
Iaccarino, JM; Clark, J; Bolton, R; Kinsinger, L; Kelley, M; Slatore, CG; Au, DH; Wiener, RS
Published in: Ann Am Thorac Soc
November 2015

RATIONALE: Multiple guidelines now recommend low-dose computed tomography (LDCT) screening for lung cancer. Given their central role in the planning of LDCT screening programs, pulmonologists' beliefs about LDCT screening will affect the safety, cost-effectiveness, and success of LDCT screening implementation. OBJECTIVES: To assess pulmonologists' propensity to offer lung cancer screening and their perceptions about LDCT screening. METHODS: We performed a national web-based survey, administered July 2013 to February 2014, among all staff pulmonologists active in Veterans Health Administration pulmonary clinics. The primary outcome was screening propensity (on the basis of responses to clinical vignettes) in relation to guidelines. Using bivariate and multinomial logistic regression, we assessed how perceptions of the evidence, trade-offs, and barriers to implementation of LDCT screening programs affected propensity to screen. MEASUREMENTS AND MAIN RESULTS: Of 573 eligible pulmonologists e-mailed, 286 (49.9%) participated. Approximately one-half (52.4%) had a propensity for guideline-concordant screening, 22.7% for overscreening, and 24.9% for underscreening. In bivariate analyses, guideline concordance was associated with acceptance of trial evidence, guidelines, and the efficacy of screening. In multivariable models, underscreeners were more likely to cite the potential harms of screening (e.g., false-positive findings, radiation exposure, incidental findings, unfavorable cost-benefit ratio), as influential factors (relative risk, 3.9; 95% confidence interval, 1.5-9.67) and were less influenced by trial evidence and guidelines (relative risk, 0.06; 95% confidence interval, 0.02-0.2), as compared with guideline-concordant screeners. Local resource availability did not significantly affect screening propensity, but insufficient infrastructure and personnel were commonly perceived barriers to implementation. CONCLUSIONS: Pulmonologists have varied perceptions of the evidence and trade-offs of LDCT screening, leading to the potential for over- and underscreening. To minimize potential harms as LDCT screening is widely implemented, physicians must understand which patients are appropriate candidates and engage those patients in a shared decision-making process regarding the trade-offs of LDCT screening.

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Published In

Ann Am Thorac Soc

DOI

EISSN

2325-6621

Publication Date

November 2015

Volume

12

Issue

11

Start / End Page

1667 / 1675

Location

United States

Related Subject Headings

  • United States
  • Tomography, X-Ray Computed
  • Practice Guidelines as Topic
  • Physicians
  • Mass Screening
  • Male
  • Lung Neoplasms
  • Logistic Models
  • Humans
  • Health Care Surveys
 

Citation

APA
Chicago
ICMJE
MLA
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Iaccarino, J. M., Clark, J., Bolton, R., Kinsinger, L., Kelley, M., Slatore, C. G., … Wiener, R. S. (2015). A National Survey of Pulmonologists' Views on Low-Dose Computed Tomography Screening for Lung Cancer. Ann Am Thorac Soc, 12(11), 1667–1675. https://doi.org/10.1513/AnnalsATS.201507-467OC
Iaccarino, Jonathan M., Jack Clark, Rendelle Bolton, Linda Kinsinger, Michael Kelley, Christopher G. Slatore, David H. Au, and Renda Soylemez Wiener. “A National Survey of Pulmonologists' Views on Low-Dose Computed Tomography Screening for Lung Cancer.Ann Am Thorac Soc 12, no. 11 (November 2015): 1667–75. https://doi.org/10.1513/AnnalsATS.201507-467OC.
Iaccarino JM, Clark J, Bolton R, Kinsinger L, Kelley M, Slatore CG, et al. A National Survey of Pulmonologists' Views on Low-Dose Computed Tomography Screening for Lung Cancer. Ann Am Thorac Soc. 2015 Nov;12(11):1667–75.
Iaccarino, Jonathan M., et al. “A National Survey of Pulmonologists' Views on Low-Dose Computed Tomography Screening for Lung Cancer.Ann Am Thorac Soc, vol. 12, no. 11, Nov. 2015, pp. 1667–75. Pubmed, doi:10.1513/AnnalsATS.201507-467OC.
Iaccarino JM, Clark J, Bolton R, Kinsinger L, Kelley M, Slatore CG, Au DH, Wiener RS. A National Survey of Pulmonologists' Views on Low-Dose Computed Tomography Screening for Lung Cancer. Ann Am Thorac Soc. 2015 Nov;12(11):1667–1675.

Published In

Ann Am Thorac Soc

DOI

EISSN

2325-6621

Publication Date

November 2015

Volume

12

Issue

11

Start / End Page

1667 / 1675

Location

United States

Related Subject Headings

  • United States
  • Tomography, X-Ray Computed
  • Practice Guidelines as Topic
  • Physicians
  • Mass Screening
  • Male
  • Lung Neoplasms
  • Logistic Models
  • Humans
  • Health Care Surveys