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.