Pack-Year Cigarette Smoking History for Determination of Lung Cancer Screening Eligibility. Comparison of the Electronic Medical Record versus a Shared Decision-making Conversation.

Publication Title

Ann Am Thorac Soc

Authors

Hannah E Modin, Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington
Joelle T Fathi, Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington
Christopher R Gilbert, Swedish Cancer Institute Seattle, WashingtonFollow
Candice L. Wilshire, Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, 1101 Madison Street, Suite 900, Seattle, WA, 98104, USA.Follow
Andrew K Wilson, Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington
Ralph W Aye, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WashingtonFollow
Alexander S Farivar, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WashingtonFollow
Brian E Louie, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WashingtonFollow
Eric Vallières, Division of Thoracic Surgery, Swedish Cancer InstituteFollow
Jed A Gorden, Swedish Cancer Institute Seattle, WashingtonFollow

Document Type

Article

Publication Date

8-1-2017

Keywords

Aged; Cigarette Smoking; Communication; Decision Making; Early Detection of Cancer; Electronic Health Records; Female; Humans; Lung Neoplasms; Male; Middle Aged; Referral and Consultation; Retrospective Studies; Risk Assessment; Tomography, X-Ray Computed; Washington

Abstract

RATIONALE: Implementation of lung cancer screening programs is occurring across the United States. Programs vary in approaches to patient identification and shared decision-making. The eligibility of persons referred to screening programs, the outcomes of eligibility determination during shared decision-making, and the potential for the electronic medical record (EMR) to identify eligible individuals have not been well described.

OBJECTIVES: Our objectives were to assess the eligibility of individuals referred for lung cancer screening and compare information extracted from the EMR to information derived from a shared decision-making conversation for the determination of eligibility for lung cancer screening.

METHODS: We performed a retrospective analysis of individuals referred to a centralized lung cancer screening program serving a five-hospital health services system in Seattle, Washington between October 2014 and January 2016. Demographics, referral, and outcomes data were collected. A pack-year smoking history derived from the EMR was compared with the pack-year history obtained during a shared decision-making conversation performed by a licensed nurse professional representing the lung cancer screening program.

RESULTS: A total of 423 individuals were referred to the program, of whom 59.6% (252 of 423) were eligible. Of those, 88.9% (224 of 252) elected screening. There was 96.2% (230 of 239) discordance in pack-year smoking history between the EMR and the shared decision-making conversation. The EMR underreported pack-years of smoking for 85.2% (196 of 230) of the participants, with a median difference of 29.2 pack-years. If identification of eligible individuals relied solely on the accuracy of the pack-year smoking history recorded in the EMR, 53.6% (128 of 239) would have failed to meet the 30-pack-year threshold for screening.

CONCLUSIONS: Many individuals referred for lung cancer screening may be ineligible. Overreliance on the EMR for identification of individuals at risk may lead to missed opportunities for appropriate lung cancer screening.

Area of Special Interest

Cancer

Specialty/Research Institute

Oncology

Specialty/Research Institute

Pulmonary Medicine

DOI

10.1513/AnnalsATS.201612-984OC