Dr. Gerard Criner is the chair and a professor of thoracic medicine and surgery at the Lewis Katz School of Medicine at Temple University and director of the Temple Lung Center.
Criner said during an interview about Lung Cancer Awareness Month5 that the earlier guidelines were limited in that studies failed to recruit women and minorities, so they were based on data that didn’t incorporate those groups for whom the cancer risk can be greater with a lower-volume smoking history.6 And while he’s hopeful the new guidelines will increase the screening numbers, he said one of the primary barriers to increased screening rates is a cumbersome shared decision-making process for patients.
Unlike other screenings, a primary care physician must have a face-to-face consultation with a patient ahead of ordering a low-dose CT scan for lung cancer, for instance, which must be documented before the Centers for Medicare and Medicaid Services (CMS) will approve the scan, he said.
The process can be even more cumbersome for older patients, some of whom may be on supplemental oxygen and need assistance getting to and from appointments, he said.
“If they can come in and get a test, that’s easy,” Criner said. “If they have to come in and get an office visit first to do shared decision making before the order can get in … that’s another element of an obstacle to them.”
During the COVID pandemic, telehealth visits were allowed for shared decision-making, a change Criner would like to see made permanent.
But some of the discussion points that go into shared decision-making aren’t even germane to the lung-cancer screening and could instead be discussed between doctor and patient in the event treatment is necessary, Criner said. He advocates streamlining the process by developing an easily understandable, scripted communication made available to patients in writing or via video before undergoing a scan, he said.
In order to better facilitate and manage lung cancer screenings, Criner points to the creation of centers of excellence. A larger health system could employ a spoke-and-hub approach in which the “mother ship” would house the centralized infrastructure and primary care physicians administer screenings. That data is then fed into the central hub, where navigators monitor results and direct patients, as needed, to pulmonary specialists, Criner said.
Changing policy surrounding shared decision-making and screenings is a heavy lift, so Criner strongly advocates for increased public outreach and education.
“To be honest, I think most of the public doesn't even know this exists,” he said of lung cancer screening recommendations.
It would seem that, as with many technologies, the “if they build it, they will come,” mentality is not working with lung cancer screening. More simplicity to the decision-making process, as well as awareness-building with patients and primary care physicians, may one day turn the tide, which will mean a more hopeful outlook for lung cancer patients.