A Qualitative Analysis of Lung Cancer Screening Practices by Primary Care Physicians

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.