Why do many of America's most at-risk veterans decline annual CT lung cancer screening?
After revealing that a substantial number of veterans decline yearly lung cancer screening, experts dug deeper into what factors might influence their decision to opt out.
Their analysis included more than 43,000 eligible U.S. veterans, 32% of whom were observed to have declined annual CT screening for lung cancer. While it isn’t just veterans who forego lung cancer screening—prior studies have indicated that the exam is widely underutilized—the Veterans Health Administration offers researchers a diverse database of patients that could provide more detailed insight into what causes patients to skip their recommended screenings.
“As the largest national health system in the US, the VHA provides cancer screening and care for millions of veterans from diverse geographic and sociodemographic backgrounds across multiple facilities, allowing exploration of the association of patient- and facility-level factors with LCS decisions,” corresponding author of the study Eduardo R. Núñez, MD, from the Pulmonary Center at Boston University School of Medicine, and colleagues explained.
Through their analysis the researchers were able to determine several factors associated with a decreased likelihood of LCS completion, including being older in age and living in more rural areas. Concerningly, the experts also noted a number of cardiovascular and mental health conditions—congestive heart failure, stroke and schizophrenia among them—linked with decreased rates of cancer screening.
Black and Hispanic veterans were more likely to accept LCS offerings, as were patients who were made aware that their screening would not require a co-payment.
The researchers also found that the variation in declining LCS screening was accounted for more—55% more to be precise—by physician and facility-level factors, suggesting that patients put more consideration into the shared decision-making process (where and with whom) than the authors previously assumed. This came as a surprise to the authors, who indicated a need to explore these specific factors more in depth in the future:
Our study suggests that physician-dependent preferences and varying facility structures and processes (eg, centralized screening programs, LCS coordinators) may affect the decision to screen more than patient-specific factors. Future work is needed to determine which facility- and physician-level factors underlie this variation and to explore opportunities for improving patient-centered shared decision-making.”
The study is available for free in JAMA.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.