Enhancing Lung Cancer Screening through Team-Based Medicine and Electronic Clinical Decision Support (CDS) in Primary Care

Abstract

Lung cancer is the leading cause of cancer deaths in the United States, but mortality significantly decreases when found early and treated. Annual lung cancer screening promotes early detection yet remains underutilized, with 1-5% of at-risk patients completing the low dose computed tomography (LDCT) scan recommended. This evidence-based practice (EBP) project aimed to increase the number of at-risk patients referred for and completing potential life-saving screening. Using the U.S. Preventative Services Task Force 2021 guidelines, process improvements in primary care were identified from a synthesis of the literature. Evidence-based practice (EBP) implementation followed the Revised Iowa Model and included team-based education, modification of electronic maintenance alerts/clinical decision supports, and shared decision-making. Outcomes of patient identification, referrals, and completion rates were compared between independent samples three months prior to and during September to December 2022. Providers and the care team utilized EBP interventions with positive feedback. The modification of alerts was partially successful and prioritized for completion by the organization. Patient referrals increased (39 vs. 26 patients), and the proportion difference was statistically significant (p= 0.020). The completion rate also improved (26 vs. 17 patients) but was not statistically significant (p=0.934). The number of patients identified for initial LDCT scans also increased but was not statistically significant (p=0.273). Data analysis may be limited due to the short implementation period and small samples; however, the increase in identification, referrals, and completion rates for at-risk patients was clinically significant and supports sustainability of process changes to enhance lung cancer screening.