TY - JOUR
T1 - Attitudes of Clinicians about Screening Head and Neck Cancer Survivors for Lung Cancer Using Low-Dose Computed Tomography
AU - Dukes, Kimberly
AU - Seaman, Aaron T.
AU - Hoffman, Richard M.
AU - Christensen, Alan J.
AU - Kendell, Nicholas
AU - Sussman, Andrew L.
AU - Vélez-Bermúdez, Miriam
AU - Volk, Robert J.
AU - Pagedar, Nitin A.
N1 - Publisher Copyright:
© The Author(s) 2019.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Objective: National guidelines recommend lung cancer screening (LCS) using low-dose computed tomography (LDCT) for high-risk patients, including survivors of other tobacco-related cancers like head and neck cancer (HNC). This qualitative study investigated clinicians’ practices and attitudes toward LCS with LDCT with patients who have survived HNC, in the context of mandated requirements for shared decision making (SDM) using decision aids. Methods: Thematic analysis of transcribed semi-structured clinician interviews and focus group. Results: Clinicians recognized LCS’ utility for some HNC survivors with smoking histories. However, they identified many challenges to SDM in diverse clinic settings, including time, workflow, uncertainty about guidelines and reimbursement, decision aids, competing patient priorities, unclear evidence, potentially heightened patient receptivity and stress, and the complexity of discussions. They also identified challenges to LCS implementation. Conclusions: While clinicians feel that LDCT LCS may benefit some HNC survivors, there are barriers both to implementing LCS SDM for these patients in primary care as currently recommended and to integrating it into cancer clinics. Challenges for SDM across settings include a lack of decision aids tailored to patients with cancer histories. Given recommendations to broaden LCS eligibility criteria, more research may be required before refinement of current guidelines.
AB - Objective: National guidelines recommend lung cancer screening (LCS) using low-dose computed tomography (LDCT) for high-risk patients, including survivors of other tobacco-related cancers like head and neck cancer (HNC). This qualitative study investigated clinicians’ practices and attitudes toward LCS with LDCT with patients who have survived HNC, in the context of mandated requirements for shared decision making (SDM) using decision aids. Methods: Thematic analysis of transcribed semi-structured clinician interviews and focus group. Results: Clinicians recognized LCS’ utility for some HNC survivors with smoking histories. However, they identified many challenges to SDM in diverse clinic settings, including time, workflow, uncertainty about guidelines and reimbursement, decision aids, competing patient priorities, unclear evidence, potentially heightened patient receptivity and stress, and the complexity of discussions. They also identified challenges to LCS implementation. Conclusions: While clinicians feel that LDCT LCS may benefit some HNC survivors, there are barriers both to implementing LCS SDM for these patients in primary care as currently recommended and to integrating it into cancer clinics. Challenges for SDM across settings include a lack of decision aids tailored to patients with cancer histories. Given recommendations to broaden LCS eligibility criteria, more research may be required before refinement of current guidelines.
KW - decision making
KW - early detection of cancer
KW - head and neck neoplasms
KW - lung neoplasms
KW - qualitative research
KW - shared
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U2 - 10.1177/0003489419868245
DO - 10.1177/0003489419868245
M3 - Article
C2 - 31409114
AN - SCOPUS:85071517448
SN - 0003-4894
VL - 129
SP - 23
EP - 31
JO - Annals of Otology, Rhinology and Laryngology
JF - Annals of Otology, Rhinology and Laryngology
IS - 1
ER -