ASPO Abstracts
Nurse Practitioners’ Lung Cancer Screening Knowledge, Attitudes and Clinical Behaviors in the United States: A Mixed Methods Study
Category: Early Detection & Risk Prediction, Early Detection & Risk Prediction
Conference Year: 2018
Abstract Body:
Background: Despite declining incidence rates, lung cancer is still a leading cause of cancer mortality. About 75% of lung cancer patients are diagnosed in locally advanced or metastatic stages with low 5-year survival rates. Low-dose computed tomography (LDCT) may increase the earlier detection and survival rates. The growth in the number of advanced practice nurses (NPs) in primary care increases the likelihood that an NP will serve as a patient’s primary care provider. This study examined knowledge, attitudes, and clinical behaviors regarding lung cancer screening among primary care NPs. Methods: An explanatory, sequential, mixed-method design used a 32-item questionnaire to measure knowledge, attitudes, and behaviors with LDCT screening and shared decision-making followed by a semi-structured qualitative telephone interview. Survey and interview question development were guided by a conceptual framework representing a temporal sequence for behavior change and potential barriers to guideline adherence. Results: 380 NPs responded. A majority were board certified (98%), specialized in family medicine (78%) and held a master’s degree (87%). The majority had correct knowledge (68%) about which patients qualified for LDCTs. A substantial majority (79%) agreed that the benefits outweighed the risks. Qualitative interviews facilitated a deeper interpretation of the survey responses. Three themes emerged: Screening decision-making: Competing demands; Guideline adherence: Identifying and responding to patient challenges; and Optimizing evidence-based practice: Provider facilitators and barriers. Administrative support, an EMR that generated screening reminders and decision aids facilitated discussions with high-risk patients. Low demand, patient financial issues and practice patterns were major barriers. Conclusions: NPs believe that shared decision making about lung cancer screening is within their scope of primary care practice, yet their influence is limited to improve screening uptake in time constrained primary care work settings. Disseminating clinical practice guidelines and authorizing health insurance reimbursement is not enough. A culture change is needed where cancer prevention and early detection have greater value for providers and patients.
Keywords: Early detection of lung cancer, lung neoplasms, mass screening, primary health care, nurse practitioners