Jennifer L. Logan, MD, MPH
The structure of the lung cancer detection programs (LCS) in the United States varies according to the availability of resources, experience in providers, type of institution and interests of the organization. Often, these programs are developed through the reorganization of pre-existing multidisciplinary models that offer services related to lung cancer. MD Magazine® informed experts from various medical centers around the country to get detailed information about the approaches to their programs.
LCS programs are usually in 1 of 3 categories: centralized, decentralized or hybrid.
Centralized LCS programs are resource-intensive and usually require the services of a coordinator, a clinical leader and a multidisciplinary team. Among the services offered by these programs is education; hiring for the selection; programming; and sorting, performance and interpretation of the tests. These programs also play an important role in the organization of inquiries, evidence of follow-up and follow-up of patient results.
By contrast, decentralized programs offer detection and interpretation services for reference providers, responsible for other aspects of care, such as referral and tracking of results.
Hybrid lung cancer detection programs use a combination of centralized and decentralized services. The components not treated by the detection program are managed by doctors of primary care of the patients.
The US Preventive Services Workforce (USPSTF), which published the latest guidelines for lung cancer detection in 2013, emphasizes the importance of shared decision making in the implementation of the # 39; a program for the detection of lung cancer.1 Instead of recommending in a uniform way that all patients who meet the criteria of choice are reviewed, the USPSTF specifically states that patients should participate in a discussion about possible known and unknown benefits, limitations, and damages.1
Researchers at the Cleveland Clinic have recently published results that show that patients participating in shared decision-making visits to detect lung cancer had improved their knowledge of age and history eligibility criteria of smoking for screening, as well as the damages and benefits associated with it.2
This shared decision-making model has been adopted by centralized lung cancer detection programs, as well as by many hybrid programs. To better understand how centralized lung cancer detection programs are implementing shared decision-making and other components, MD Magazine® He spoke with Kim Sandler, MD, co-director of the Vanderbilt Lung Screening program, to find out how the program works at the Vanderbilt University Medical Center.
"We offer shared visits to decision-making for all our patients and by doing so, the burden of referral providers can be significantly reduced," Dr. Sandler explained. The program also offers advice on smoking cessation, document components of the prostate, lung, colorectal and ovarian risk prediction model, monitoring of abnormal finding coordinates and routine monitoring schedules.
Panelists from various medical centers throughout the country have provided details on the approaches of their programs to implement programs for the detection of centralized, decentralized or hybrid lung cancer.
The participating organizations were predominantly academic medical centers (9), with other panelists representing community teaching hospitals (2), large multispecial group practices (3), a private healthcare system (1) and a hospitality system for Veterans Affairs (1) . Organizations were mainly located in four geographic regions: Massachusetts, the Midwest, the West Coast, and New York, New York.
Of the 16 participating organizations, 9 indicated that they used a model for the detection of hybrid lung cancer that included both centralized and decentralized components. An organization uses a decentralized system and 5 use a centralized system.
All organizations were informed of hybrid and centralized programs through a centralized monitoring system. The programs differed more than how the selection orders are processed. While centralized programs have staff that complete this process, hybrid systems are generally confident in ordering the orders initiated by the provider.
Lung cancer detection programs, whether centralized, hybrid or decentralized, are often governed by a management committee or by another multidisciplinary team. The specialists in the field of pulmonary medicine, radiology, medical oncology, thoracic surgery and radiation oncology participate in the organizational efforts to establish policies and procedures and control the application.
To monitor the lung cancer detection activities, organizations use several tools. Electronic records based on medical records and other commercially developed databases are commonly used, as well as dedicated and non-dedicated internal databases developed by individual institutions.
Organizations offer a wide range of patients with lung cancer detection programs. Most programs report serving minority groups, including African Americans and Hispanics. Other groups that benefit from these programs include socially-economically disadvantaged populations that do not have medical insurance or have Medicaid. Among the less organized groups, the groups that communicate do not live in urban areas in general; immigrants; and military members.
Sandler supports the movement towards the centralization of lung cancer detection services. "There are huge benefits to having a centralized program," he said. "We have seen a significant increase in enrollment since moving to a centralized program. Our adherence rate [has] It also increased drastically.
"I think that there is more integration through the hospital system, the better," Sandler continued. "Primary care doctors, radiologists, oncologists, surgeons and others want to provide the best care for patients. We know that screening of lung cancer saves lives and we know that very few eligible patients are registered. We have a multidisciplinary team, and we are working to continue increasing the awareness of pulmonary screening in our area. "
- Thomson CC, McKee A, Borondy-Kitts A, et al; American Thoracic Society and American Lung Association. Implementation guide for the screening of lung cancer. lung.org/assets/documents/lung-cancer/implementation-guide-for-lung.pdf. Accessed November 5, 2018.
- Mazzone PJ, Tenenbaum A, Seeley M, et al. Impact of a lung cancer screening and shared decision-making visit. Chest 2017; 151 (3): 572-578. doi: 10.1016 / j.chest.2016.10.027.