The Lung Cancer Screening Team
Putting together a cohort to develop a screening program requires a mix of skills and a shared purpose.
No specialty can singlehandedly take on the task of screening patients for lung cancer. With that in mind, an ACR 2016 session brought together a multidisciplinary panel to focus on the ins and outs of setting up a lung cancer screening program from a variety of perspectives.
The session included representatives from radiology, primary care, hospital administration, pulmonary medicine, clinic operations, and nursing. While radiologists are the logical leaders of lung cancer screening programs, all presenters emphasized the importance of building strong, functional teams among diverse specialists.
The topic was extremely timely due to recent legislation extending coverage of lung cancer screening to a wider group of patients. In response, a growing number radiology practices are answering the call to offer screening to their patients.
When building a lung screening program, diversity is key, said Geoffrey Rubin, MBA, MD, FACR, George B. Geller Distinguished Professor of Radiology and Bioengineering at Duke University. “If you can compose a group that is more diverse, you will have many more ideas,” said Rubin. Which is not to say group members will always agree. However, noted Rubin, “conflict and debate are signs of a creative team and are ultimately a very important process in the work of a team.”
Roger Luckmann, MD, MPH, associate professor of family medicine and community health at University of Massachusetts Medical School, echoed Rubin’s discussion of teamwork. Representing the family medicine and community health perspective, Luckman discussed different models for collaborating around shared patient responsibilities. He pointed out that while some primary care practices may be willing and able to take on nearly all tasks in a lung cancer screening program, many others practice in an environment that limits their capacity to perform some tasks efficiently and effectively. “Programs should consider active engagement of primary care physicians in shaping an optimal plan to share responsibilities,” said Luckmann.
Andrea McKee, MD, chair of radiation oncology at the Lahey Hospital and Medical Center Sophia Gordon Cancer Center, began her presentation on financial modeling for implementing a screening program with some words of advice. “If you’re going to do this, don’t dabble in it,” she said. “Get out there and educate your patients and referring physicians.” The more you get the word out about the importance of screening, the more lives you can potentially save and the faster you will recoup the costs of setting up the program in the first place.
Shawn Regis, PhD, consultant at Medtronic PLC, dug further into the administrative conference related to setting up a lung cancer screening program. “Maintaining accurate patient-follow up is essential for a successful lung screening program,” said Regis, “and a database, structured reporting system, and navigator/coordinator are necessary to do this for a large population.” A navigator or coordinator might be a nurse practitioner or a physician assistant, who can guide patients through the screening process.
And engaging patients during screening and follow-up is paramount, emphasized Francine L. Jacobson, MD, MPH, medical director of lung cancer screening at Brigham and Women’s Health Care. When speaking with patients, Jacobson encouraged physicians to be clear and transparent. “Don’t shy away from showing a bit of the science,” she said. “Just adjust based on your audience.” She also acknowledged the judgement that many patients face when being screened for (let alone being diagnosed with) lung cancer. “Talking to the public should stress destigmatizing lung cancer as a disease,” she said.
Jacobson’s patient-focused attitude is evident in her radiology reports, which she writes with the patient audience in mind. Sometimes she includes congratulations for patients who have quit smoking. “Whatever will improve a patient’s health warrants a space on the page,” she says. When it comes to establishing a lung cancer screening program, Jacobson sums it up in two words: “patient engagement. The patient is the central focus on the dialog to improve their health.”