Abstract
Lung cancer is the leading cause of cancer death in the United States, but no scientific organization currently recommends screening because of limited evidence for its effectiveness. Despite this, physicians often order screening tests such as chest X-rays and computerized tomography scans for their patients. Limited information is available about how physicians decide when to order these tests. To identify factors that affect whether physicians’ screen patients for lung cancer, we conducted five 75-min telephone-based focus groups with 28 US primary care physicians and used inductive qualitative research methods to analyze their responses. We identified seven factors that influenced these physicians’ decisions about screening patients for lung cancer: (1) their perception of a screening test’s effectiveness, (2) their attitude toward recommended screening guidelines, (3) their practice experience, (4) their perception of a patient’s risk for lung cancer, (5) reimbursement and payment for screening, (6) their concern about litigation, and (7) whether a patient requested screening. Because these factors may have conflicting effects on physicians’ decisions to order screening tests, physicians may struggle in determining when screening for lung cancer is appropriate. We recommend (1) more clinician education, beginning in medical school, about the existing evidence related to lung cancer screening, with emphasis on the benefit of and training in tobacco use prevention and cessation, (2) more patient education about the benefits and limitations of screening, (3) further studies about the effect of patients’ requests to be screened on physicians’ decisions to order screening tests, and (4) larger, quantitative studies to follow up on our formative data.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
U.S. Cancer Statistics Working Group. (2010). United States cancer statistics: 1999–2007 incidence and mortality. Web-based Report. U.S. Department of Health and Human Services 2010.
Altekruse, S. F., Kosary, C. L., Krapcho, M., et al. (Eds.). (2010). SEER cancer statistics review, 1975–2007. National Cancer Institute, Bethesda, MD. http://seer.cancer.gov/csr/1975_2007/, based on November 2009 SEER data submission, posted to the SEER web site.
Smith, R. A., Glynn, T. J. (2000). Early lung cancer detection: Current and ongoing challenges. Cancer, 89(11 Suppl), 2327–2328.
Humphrey, L. L., Teutsch, S., Johnson, M. (2004). Lung cancer screening with sputum cytologic examination, chest radiography, and computed tomography: An update for the U.S. preventive services task force. Annals of Internal Medicine, 140(9), 740–753.
Lung Cancer Alliance. (2010). Current early detection options. http://www.lungcanceralliance.org/eirc/screen/screening_positions.html. Accessed 29 Dec 2010.
Bach, P. B., Jett, J. R., Pastorino, U., Tockman, M. S., Swensen, S. J., & Begg, C. B. (2007). Computed tomography screening and lung cancer outcomes. JAMA, 297(9), 953–961.
Menezes, R. J., Roberts, H. C., Paul, N. S., et al. (2010). Lung cancer screening using low-dose computed tomography in at-risk individuals: The Toronto experience. Lung Cancer, 67(2), 177–183.
Henschke, C. I., Yankelevitz, D. F., Libby, D. M., Pasmantier, M. W., Smith, J. P., & Miettinen, O. S. (2006). Survival of patients with stage I lung cancer detected on CT screening. New England Journal of Medicine, 355(17), 1763–1771.
Harris, G. (2008). Cigarette company paid for lung cancer study. http://www.nytimes.com/2008/03/26/health/research/26lung.html. Accessed 6 Nov 2010.
Hocking, W. G., Hu, P., Oken, M. M., et al. (2010). Lung cancer screening in the randomized prostate, lung, colorectal, and ovarian (PLCO) cancer screening trial. Journal of the National Cancer Institute, 102(10), 722–731.
Clark, K. W., Gierada, D. S., Marquez, G., et al. (2009). Collecting 48,000 CT exams for the lung screening study of the national lung screening trial. Journal of Digital Imaging, 22(6), 667–680.
Harris, G. (2010). CT scans cut lung cancer deaths, study finds. http://www.nytimes.com/2010/11/05/health/research/05cancer.html?_r=3&hp. Accessed 6 Nov 2010.
Klabunde, C. N., Marcus, P. M., Silvestri, G. A., et al. (2010). U.S. primary care physicians’ lung cancer screening beliefs and recommendations. American Journal of Preventive Medicine, 39(5), 411–420.
Charmaz, K. (2004). Premises, principles, and practices in qualitative research: Revisiting the foundations. Qualitative Health Research, 14(7), 976–993.
Macqueen, K. M., McLoughlin, K., Alleman, P., Burke, H. M., & Mack, N. (2008). Partnering for care in HIV prevention trials. Journal of Empirical Research on Human Research Ethics, 3(4), 5–18.
Miles, M. B., & Huberman, M. (1994). An expanded sourcebook: Qualitative data analysis (2nd ed.). Thousand Oaks, CA: Sage.
McGlynn, E. A., Asch, S. M., Adams, J., et al. (2003). The quality of health care delivered to adults in the United States. New England Journal of Medicine, 348(26), 2635–2645.
Nelson, H. D., Tyne, K., Naik, A., Bougatsos, C., Chan, B. K., Humphrey, L. (2009). Screening for breast cancer: An update for the U.S. preventive services task force. Annals of Internal Medicine, 151(10), 727–737, W237–W742.
Stinchcombe, T. E., Detterbeck, F. C., Lin, L., Rivera, M. P., & Socinski, M. A. (2007). Beliefs among physicians in the diagnostic and therapeutic approach to non-small cell lung cancer. Journal of Thoracic Oncology, 2(9), 819–826.
Burger, I. M., Kass, N. E., Sunshine, J. H., & Siegelman, S. S. (2008). The use of CT for screening: A national survey of radiologists’ activities and attitudes. Radiology, 248(1), 160–168.
Brawley, O. W., & Kramer, B. S. (2005). Cancer screening in theory and in practice. Journal of Clinical Oncology, 23(2), 293–300.
Palda, V. A., Davis, D., & Goldman, J. (2007). A guide to the Canadian medical association handbook on clinical practice guidelines. CMAJ, 177(10), 1221–1226.
Bach, P. B., Silvestri, G. A., Hanger, M., & Jett, J. R. (2007). Screening for lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest, 132(3 Suppl), 69S–77S.
Smith, R. A., Cokkinides, V., Brooks, D., Saslow, D., & Brawley, O. W. (2010). Cancer screening in the United States, 2010: A review of current American cancer society guidelines and issues in cancer screening. CA Cancer J Clin, 60(2), 99–119.
Acknowledgments
The analysis presented in this article was led by the lead author in part to fulfill the practicum portion of her MPH degree. Research Triangle Institute (RTI), Durham, NC assisted with protocol development, performed the sample selection, conducted the focus groups, and prepared transcripts. Funding support was provided by the Centers for Disease Control and Prevention (contract number 200-2002-00575). The authors would like to express their appreciation to the study participants.
Author information
Authors and Affiliations
Corresponding author
Additional information
Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Rights and permissions
About this article
Cite this article
Henderson, S., DeGroff, A., Richards, T.B. et al. A Qualitative Analysis of Lung Cancer Screening Practices by Primary Care Physicians. J Community Health 36, 949–956 (2011). https://doi.org/10.1007/s10900-011-9394-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10900-011-9394-2