Publications

Attitudes of Clinicians about Screening Head and Neck Cancer Survivors for Lung Cancer Using Low-Dose Computed Tomography.

Author(s): Dukes K,  Seaman AT,  Hoffman RM,  Christensen AJ,  Kendell N,  Sussman AL,  Vélez-Bermúdez M,  Volk RJ,  Pagedar NA

Journal: Ann Otol Rhinol Laryngol

Date: 2020 Jan

Major Program(s) or Research Group(s): NCORP

PubMed ID: 31409114

PMC ID: PMC6945809

Abstract: 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.