An Indiana University cancer researcher will study why high-risk patients eligible for lung cancer screening are not referred in greater numbers for the non-invasive procedure.
Lisa Carter-Harris, PhD, has been awarded $100,000 by the American Lung Association for a two-year behavioral study of primary care clinicians to identify barriers associated with low referral rates for the screening that has been recommended by the U.S. Preventive Services Task Force since 2013. Dr. Carter-Harris is an assistant professor of nursing at the IU School of Nursing and a research member of the Cancer Prevention and Control program at the Indiana University Melvin and Bren Simon Cancer Center.
“Compared to colon cancer and breast cancer screening, lung cancer screening has much lower rates of participation,” Dr. Carter-Harris said. “Our hypothesis is that there are specific biases and stigma related to smoking as a cause of the cancer. What we want to look at nationally is what’s driving the low rates of discussion between clinicians and patients and the low rates of screening.
The US Preventive Services Task Force recommended that all individuals between the ages of 55 and 80 years who have a smoking history of 30 pack-years or longer, and who currently smoke or have quit within the past 15 years, should have a discussion with an informed clinician to make a shared decision to be screened, or not, annually for lung cancer with low-dose computed tomography or CT scan.
According to the American Lung Association, lung cancer kills more men and women than any other type of cancer. ALA research shows that the recommended screening can reduce lung cancer mortality by as much as 20 percent, yet fewer than 4 percent of the eight million eligible Americans have been screened.
“Our long-term goal is to decrease lung cancer-related mortality by early detection through screening of appropriate high-risk patients,” Dr. Carter-Harris explained. “This attitudinal study is designed to identify barriers to discussions and subsequent screening referral by primary care clinicians for eligible patients.”
Unlike previous studies, Dr. Carter-Harris will focus on primary care physicians, nurse practitioners and physician assistants—the front-line of patient care—for this national study to determine what barriers, including biases, stigma, time constraints and competing priorities may influence the occurrence of a lung cancer screening discussion as well as subsequent referral.
“Research supports that some clinicians may have an implicit bias toward lung cancer patients attributable to their status as a current or former smoker, making it highly plausible that underlying attitudes toward smokers and unintentional stigma among clinicians may be influencing referral patterns for lung cancer screening,” Dr. Carter-Harris said.
A second phase of the study will be to develop interventions to help primary care clinicians engage patients in a discussion and subsequent referral for lung cancer screening, Dr. Carter-Harris said.