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Lawrence Eric Feldman
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P2.06 - Epidemiology/Primary Prevention/Tobacco Control and Cessation (ID 707)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Epidemiology/Primary Prevention/Tobacco Control and Cessation
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.06-011 - Assessing and Addressing Knowledge Gaps to Improve Lung Cancer Screening Rates (ID 10418)
09:30 - 09:30 | Presenting Author(s): Lawrence Eric Feldman
- Abstract
Background:
In 2011, the National Lung Screening Trial showed that annual screening with low-dose computed tomography (LDCT) in high-risk patients reduced lung cancer mortality by 20%. The United States Preventative Services Task Force (USPSTF) now recommends lung cancer screening (LCS) for high-risk individuals (Grade B). Evidence from the National Health Interview Survey suggests that only 2-4% of eligible individuals are referred for LDCT, likely in part due to a lack of familiarity among primary care physicians with LCS guidelines. In this analysis, we sought to obtain a baseline acumen of providers’ knowledge and awareness about LCS and develop a series of interventions including embedding USPSTF criteria into electronic medical record (EMR) ordering to educate providers and facilitate more effective use of LCS for high-risk patients.
Method:
We surveyed internal medicine residents at the University of Illinois – Chicago (UIC) General Medicine Clinic (GMC) using paper surveys. The survey included six questions on USPSTF LCS guidelines. Next, educational efforts were addressed through a lecture, email reminders, and informational clinic flyers. The EMR order set was updated to include USPSTF criteria directed ordering. The number of appropriately ordered screens through GMC was tracked monthly. A post-intervention survey was distributed to evaluate if providers’ knowledge was improved by educational interventions.
Result:
Fifty-three IM residents were surveyed regarding LCS guidelines and appropriateness for LDCT screening. Of the respondents, 87% knew the correct test for screening was LDCT, 66% knew only smokers with >30 pack year history were eligible, 45% knew the minimum age criteria (55 years-old), 28% knew the maximum age (80 years-old), 42% knew interval to re-order screening for a negative test (1 year), and 38% knew the maximum time since quitting (15 years). Following the initial interventions, there was an increase in the volume of appropriately ordered LDCT screening tests ordered through GMC clinic (from 6.8 per month [May 2016 to September 2016] to 10.8 per month [October 2016 to April 2017]). Post-intervention knowledge assessment is underway and will be presented.
Conclusion:
Although LCS is recommended by USPSTF, there are gaps in knowledge about eligibility criteria among internal medicine residents. We present data that suggests using educational interventions and changes in EMR to increase awareness and knowledge is associated with an increase in appropriate usage of LDCTs for LCS. Ultimately, we plan to broaden these interventions to additional primary care clinics (eg., Family Medicine, Pulmonary) to improve proper use of LCS at our institution.
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P3.10 - Nursing/Palliative Care/Ethics (ID 726)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Nursing/Palliative Care/Ethics
- Presentations: 2
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.10-002 - Implementing an Innovative Distress/Supportive Care Screening Tool in a Lung Cancer Clinic (ID 10228)
09:30 - 09:30 | Presenting Author(s): Lawrence Eric Feldman
- Abstract
Background:
The Institute of Medicine (IOM) 2013 report recommends that supportive oncology care start at cancer diagnosis; the Commission on Cancer (CoC) Standard 3.2 requires distress screening and indicated action. The Coleman Supportive Oncology Collaborative “Patient Screening Questions for Supportive Care” tool was used to investigate the relationships between demographic/diagnostic data and screening scores.
Method:
Lung cancer patients at the University of Illinois Cancer Center were screened using the following Coleman Foundation tool shown below: Figure 1 Data was collected on an Excel spreadsheet and statistically analyzed.
Result:
We performed initial screening on 138 lung cancer patients. Demographics are shown in table below: Figure 1 Statistically signifcant correlations were found with the following: --Gender and racial/ethnic minority status correlated with distress/concerns over diagnosis and treatment. --Type of medical insurance correlated with distress/concerns over nutrition (food insecurity) and physical activity.
Conclusion:
Introduction of distress screening tool facilitated identification of some care needs such as patient education and counseling, nutrition services, and physical therapy. Moreover certain demographic groups have especially high burdens in some specific patient concern areas. Our next step is to expand distress screening to determine longitudinal trends, expand supportive oncology services to meet our patients’ needs, and to assess impact on unplanned ED visits and patient outcomes.
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P3.10-003 - Assessing and Addressing Knowledge Gaps to Improve Lung Cancer Screening Rates (ID 10267)
09:30 - 09:30 | Presenting Author(s): Lawrence Eric Feldman
- Abstract
Background:
The National Lung Screening Trial showed that annual screening with low-dose computed tomography (LDCT) in high-risk patients reduced lung cancer mortality by 20%. The United States Preventative Services Task Force (USPSTF) now recommends lung cancer screening (LCS) for high-risk individuals. However only about 10% of eligible individuals are referred for LDCT possibly in part due to a lack of familiarity among primary care physicians with LCS guidelines. In this analysis, we sought to obtain a baseline acumen of providers’ knowledge and awareness about LCS and develop a series of interventions including embedding USPSTF criteria into electronic medical record (EMR) ordering to educate providers and facilitate more effective use of LCS for high-risk patients.
Method:
A Lung Cancer Screening Program was started in 2015 led by a nurse practitioner. Internal medicine residents at the University of Illinois – Chicago (UIC) General Medicine Clinic (GMC) were surveyed using paper questionnaires. The survey included 6 questions on USPSTF LCS guidelines. Next, educational efforts were addressed through a lecture, email reminders, and informational clinic flyers. Finally the EMR order set was updated to include USPSTF criteria directed ordering. The number of appropriately ordered screens through GMC was tracked monthly. A post-intervention survey was distributed to evaluate if providers’ knowledge was improved by these interventions.
Result:
Fifty-three IM residents were surveyed regarding LCS guidelines appropriate for LDCT screening. Of the respondents, 87% knew the correct test for screening was LDCT, 66% knew only smokers with >30 pack year history were eligible, 45% knew the minimum age criteria (55 years-old), 28% knew the maximum age (80 years-old), 42% knew interval to re-order screening for a negative test (1 year), and 38% knew the maximum time since quitting (15 years). Following the initial interventions there was an increase in the rate of appropriately ordered LDCT screening tests ordered through GMC clinic (from 6.8 per month [May 2016 to September 2016] to 10.8 per month [Oct. 2016 to Apr. 2017]). Post-intervention knowledge assessment is underway and will be presented.
Conclusion:
Although LCS is recommended by USPSTF, there are gaps in knowledge about eligibility criteria among internal medicine residents. We present data that suggests using educational interventions and changes in EMR to increase awareness and knowledge is associated with an increase in appropriate usage of LDCTs for LCS. Ultimately, we plan to broaden these interventions to additional primary care clinics (eg., Family Medicine, Pulmonary) to improve proper use of LCS at our institution.
