Improving lung cancer screening in real-world settings: a pragmatic approach to provider education, barriers, and solutions.

Introduction: Lung cancer is the leading cause of cancer mortality in the United States. While lung cancer screening (LCS) with low-dose computed tomography (LDCT) has been shown to have a 20% relative reduction in mortality, the real-world benefit of screening has not been realized as screening of eligible individuals remains low. Primary care providers (PCPs) play a pivotal role in identifying eligible patients, initiating shared decision-making, and coordinating follow-up care, yet many report limited knowledge and confidence in implementing LCS. Provider education is a critical, scalable intervention to address these barriers and improve screening delivery in primary care. Pilot pragmatic trials are essential for evaluating real-world strategies to increase LCS uptake in primary care settings. Methods: We utilized a clinical advisory board of LCS experts to co-develop a 30-minute LCS education curriculum tailored for primary care providers (PCPs) at a safety-net hospital in Central Indiana and assessed its' impact on PCPs' knowledge of LCS guidelines, comfort with shared decision-making (SDM), communicating LDCT results, and confidence in managing post-screening care. Results: Following completion of the LCS education curriculum, primary care providers reported increased comfortability discussing LCS and LDCT results with their patients and increased familiarity with LCS eligibility criteria, which was reflected by improved application of screening guidelines to patient scenarios. LCS referrals by primary providers also increased following implementation of the LCS education curriculum. Discussion: Implementation of the LCS education curriculum led to improved provider comfort in discussing LCS with patients, confidence in managing next steps following LDCT results, increased knowledge of LCS eligibility, and application of screening criteria to patient scenarios, which was associated with an increased number of new referrals of eligible patients to the lung cancer screening program. Future aims can be developed to expand a LCS education curriculum beyond a single primary care clinic and digitize the curriculum into interactive modules, microlearning formats, and mobile-friendly platforms to enhance accessibility for providers.