A80-2-35 False Positive Results From Lung Cancer Screening: Multi-Level Challenges and Recommendations From National Thought Leaders and Clinicians, and Staff in Two Health Systems

Introduction

A concern for lung cancer screening (LCS) is the potential harm of a false-positive result, defined as having >one nodule requiring follow-up and no lung cancer diagnosis after one-year. Our goal was to identify perceptions and experiences with false-positive results among clinicians, staff, and thought leaders.

Methods

Telephone interviews were conducted with national thought leaders and clinicians and staff at two health systems (NY, NC). Three semi-structured interview guides were developed based on LCS roles.Transcripts were double-coded in Dedoose, following standard consensus coding guidelines. Emerging themes and coding discrepancies were documented and resolved through discussion and consensus.

Results

Across two health systems, 10 clinicians who refer patients to LCS and 7 staff members were interviewed, along with 4 national thought leaders. Table 1 shows that, across groups, challenges and recommendations were categorized at the national, health system, and visit levels. At the national level, thought leaders noted confusion among clinicians about the false-positive rate because the National Lung Screening Trial used a 4mm threshold for suspicious nodules, with a rate of 20-27%, whereas with Lung-RADS the threshold is 6mm and the rate is 10%. Thought leaders recommended framing communication to convey that the LCS false-positive rate is similar to that of mammography when using Lung-RADS. At the health system level, all groups reported that, despite protocols being in place, the lack of EHR-integrated tracking systems is a major barrier, including the inability to track follow-up for suspicious nodule(s). Recommendations included developing an EHR tracking system co-created with clinicians and staff, covering all LCS timepoints, and automated notifications. Additional recommendations included better delineation of LCS workflow roles, increased LCS staffing, and increasing the number of dedicated cardiothoracic-trained radiologists reading LDCT scans to reduce the false-positive rate. At the visit level, thought leaders noted a declining emphasis on the risk of a false positive in shared decision-making conversations. All groups recommended enhancing patients’ understanding of the LCS process and the importance of communicating about potential false-positive findings during shared decision-making.

Discussion

Insights from clinicians, staff, and thought leaders on the LCS process highlighted multi-level challenges and recommendations to improve the false-positive rate. To improve the false-positive rate at the national, health system, and visit levels, recommendations include EHR-integrated tracking systems, better delineated roles, and more dedicated cardiothoracic-trained radiologists reading LDCT scans. Studies are needed to help providers identify patients who may require additional support if a suspicious nodule occurs.

This abstract is funded by: NIH/NCI