Table 3.
Low-Dose CT Influences on Decision Making and Perceived Barriers to Implementation
| Screeners (%) | Nonscreeners (%) | P Value | |
|---|---|---|---|
| Familiarity with and buy-in to relevant information about screening | |||
| Familiarity (extremely/somewhat) with clinical practice guidelines | 91 | 78 | 0.004 |
| Familiarity (extremely/somewhat) with National Lung Screening Trial findings | 91 | 77 | 0.007 |
| Belief that evidence for low-dose CT screening is strong or very strong | 95 | 78 | <0.001 |
| Major influences on decision whether or not to screen | |||
| Evidence | |||
| Clinical trial evidence | 78 | 60 | <0.001 |
| Guidelines for low-dose CT screening | 67 | 47 | <0.001 |
| Opinions of my colleagues about low-dose CT screening | 20 | 20 | 0.48 |
| Potential benefits of screening | |||
| Low-dose CT screening reduces death | 64 | 20 | <0.001 |
| Potential harms of screening | |||
| False-positive rate | 52 | 71 | 0.01 |
| Overdiagnosis of indolent tumors | 44 | 67 | 0.01 |
| Incidental findings outside lung | 31 | 53 | 0.009 |
| Radiation exposure | 13 | 42 | <0.001 |
| High cost to patient | 23 | 53 | <0.001 |
| High cost to system | 33 | 64 | <0.001 |
| Patient factors | |||
| Candidacy for surgical treatment | 60 | 51 | 0.33 |
| Local context considerations | |||
| Access to low-dose CT scanner | 58 | 44 | 0.13 |
| Availability of local experts in thoracic surgery | 44 | 40 | 0.03 |
| Availability of local experts to biopsy pulmonary nodules | 50 | 38 | 0.20 |
| System in place locally for following pulmonary nodules | 57 | 47 | 0.03 |
| Perceived major barriers to implementation of screening programs | |||
| Lack of buy-in from parties involved with screening | |||
| Lack of buy-in from primary care providers | 29 | 42 | 0.13 |
| Lack of buy-in from pulmonologists | 22 | 58 | <0.001 |
| Lack of buy-in from radiologists | 21 | 23 | 0.94 |
| Lack of buy-in from local leadership | 28 | 46 | 0.04 |
| Lack of buy-in from patients | 13 | 16 | 0.10 |
| Insufficient resources for implementation | |||
| Insufficient infrastructure for screening program | 41 | 64 | 0.005 |
| Insufficient staff to run screening program | 42 | 60 | 0.01 |
| High cost of implementation | 43 | 82 | <0.001 |
Definition of abbreviation: CT = computed tomography.
Screeners were defined as those who would offer screening to the National Lung Screening Trial–eligible patient; nonscreeners were defined as those who would not offer screening to the National Lung Screening Trial–eligible patient.