Improving Smoking History Documentation & Lung Cancer Screening in a Primary Care Clinic

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May, Erica
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Research Subject Categories::INTERDISCIPLINARY RESEARCH AREAS::Caring sciences::Nursing , Lung Neoplasms , Early Detection of Cancer , Tomography, X-Ray Computed , Smoking
Background: Lung cancer is the leading cause of cancer-related deaths in the United States (Rajupet et al., 2017). The US Preventive Service Task Force (USPSTF) recommends annual screening for lung cancer with low dose computed tomography (LDCT) in adults aged 50 to 80 years, who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years (US Preventive Services Task Force [USPSTF], 2021). Despite these guidelines, lung cancer screening is underutilized (Coughlin et al., 2019). Incomplete documentation of smoking history creates a significant challenge for determining candidates eligible for lung cancer screening (Carter-Harris et al., 2017). Methods: This quality improvement project (QI) utilized a pre-intervention and post-intervention survey to determine the impact on providers’ knowledge, attitude, or clinical practice at a rural primary clinic in North Carolina. This project focused on the deployment of the lung cancer screening tool into the electronic health record (EHR) over a three-month period. A chart review was performed on patients aged between 50 to 80, with a current or former smoking history prior. Then, again after implementing the screening tool to determine if smoking documentation and lung cancer screening referrals improved. Findings: Overall, the project demonstrated a significant difference in smoking history documentation and LDCT referrals, when incorporating a lung cancer screening tool into the EHR. The surveys revealed a weak correlation of providers’ knowledge, attitude, and clinical practice between the pre and post interventions. Conclusion: The uptake of lung cancer screening guidelines remains low (USPSTF, 2021). Wider adherence to these guidelines will require better documentation of smoking history for providers to determine if individuals are eligible (Li et al., 2018). While this project did not reveal a significant difference in the providers’ knowledge, attitude, and clinical practice, it demonstrates improved smoking history documentation and LDCT referrals.