Survey Finds Family Physicians Divided on Recommending LDCT Screening

A survey conducted among members of the South Carolina Academy of Family Physicians found that although most family physicians reported that they discussed low-dose computed tomography screening (LDCT) with their patients, referrals were low.

In 2014, the US Preventive Services Task Force (USPSTF) finalized its “B” recommendation for annual lung cancer screenings with LDCT; that recommendation was for adults ages 55 to 80 years who had smoked 30 pack years. In just over a year following this recommendation, CMS announced that eligible patients would receive Medicare coverage if they met the following criteria:

• They are age 55 to 77 years and are either current smokers or have quit smoking within the past 15 years.
• They have a tobacco smoking history of at least 30 pack years, which is at least a pack a day for 30 years. (If a person smoked 2 packs a day for 15 years that equals 30 pack years.)
• The person receives a written order from a physician or qualified nonphysician practitioner that meets certain requirements, which are contained in the national coverage determination.

But has physician attitude changed toward recommending LDCT screening in high-risk patients? To answer this question, researchers at the University of South Carolina distributed a 32-item questionnaire among family physicians in South Carolina. Of the 101 respondents, the authors found lack of adequate knowledge among the doctors. Many of them, the survey found, continued to recommend chest X-rays instead of LDCT for lung cancer screening. A majority (98%) felt that LDCT increased the odds of detecting disease earlier, and the benefits outweigh harms (75%).

The physicians did raise concerns with LDCT, including unnecessary procedures (88%), stress or anxiety (52%), and radiation exposure (50%). More than 75% of physicians discussed the risks and benefits of this procedure with their patient, but more than half of them said they had made just 1 or no recommendation for screening in the immediate past year.

The authors write that there are gaps in physician knowledge about screening guidelines and reimbursement, and recommend educational outreach, using decision aids, to facilitate shared decision-making discussions about screening.

Reference

Ersek JL, Eberth JM, McDonnell KK, et al. Knowledge of, attitudes toward, and use of low-dose computed tomography for lung cancer screening among family physicians [published online June 3, 2016]. Cancer. doi:10.1002/cncr.29944.