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J Am Assoc Nurse Pract. 2019 Jan;31(1):33-45. doi: 10.1097/JXX.0000000000000096.

Lung cancer screening: Practice guidelines and insurance coverage are not enough.

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College of Nursing, University of South Carolina.
The Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina.
Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina.



Low-dose computed tomography (LDCT) is expected to increase early detection of lung cancer and improve survival. The growth in the number of advanced nurse practitioners (NPs) in primary care settings increases the likelihood that an NP will serve as a patient's provider. This study's purpose was to examine knowledge, attitudes, and practices regarding LDCT among NPs who work in primary care settings.


An explanatory, sequential, mixed-method design used a 32-item questionnaire, followed by a semi-structured telephone interview. The development of the survey and interview questions were guided by a conceptual framework representing a temporal sequence for behavior change and potential barriers to guideline adherence.


Nurse practitioners believe that shared decision making with their high-risk patients about LDCT is within their scope of their practice. Working in time-constrained primary care settings, NPs have limited abilities to improve the uptake of LDCT. Substantial patient barriers exist that deter follow through on providers' recommendation. Disseminating guidelines and authorizing health insurance reimbursement is insufficient.


Research is needed that investigates the screening process so that barriers can be closely studied. Culture change is needed where early detection has greater value for insurers, providers, and patients.

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