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. 2017 Dec;14(12):1827–1835. doi: 10.1513/AnnalsATS.201703-237OC

Table 5.

Challenges and potential solutions to facilitate successful care processes for lung cancer screening based on combined experience at participating sites

Care Process Challenges Potential Solutions
Determine eligibility Not offering screening to eligible patients Implement dashboard alert in EHR to flag eligible patients based on age and smoking history
Offering screening to patients who are not eligible Employ navigator or eConsult mechanism to confirm eligibility
Use standardized order templates that require free-text entry of age and smoking history
Engage in shared decision-making Offering screening without sufficient provision of information Make tools for SDM available to patients and providers in multiple formats, including paper based, Internet based, and video based
Provide smoking cessation counseling Not offering smoking cessation counseling to those eligible Include option to refer for smoking cessation counseling in lung cancer screening order sets
Use EHR to trigger automatic referral for smoking cessation counseling
Embed electronic orders for nicotine replacement therapy and varenicline in lung cancer screening order sets
Interpret low-dose CT scans Lack of standardization in documentation of results Create standardized templates with Lung-RADS categories and/or specific fields for nodule size, attenuation, and other characteristics
Employ dedicated chest radiologists or other specialized readers
Coordinate referrals; encourage adherence with follow-up testing and repeat annual screening Delays in care and losses to follow-up Employ navigator to coordinate care
Assign patients to specific tracks for follow-up and include track assignment on dashboard in EHR

Definition of abbreviations: CT = computed tomographic; eConsult = electronic consult; EHR = electronic health record; Lung-RADS = Lung CT Screening Reporting and Data System; SDM = shared decision-making.