Abstract
Background: Lung cancer is often diagnosed late when treatment options are limited. The goal of screening for lung cancer with low dose CT is to diagnose at an earlier stage, when more treatment options including potentially curative surgery are available. Our Regional Cancer Center partnered with Thoracic Surgery to develop a nurse practitioner led screening program to ensure that eligible patients are screened following current guidelines. The process is cumbersome for providers as the reimbursement process requires specific, time consuming documentation which may prevent providers from offering screening. There is a high rate of incidental findings which providers may be uncomfortable managing. Potential exists for patients to be lost to followup. Screening for cancer is also anxiety provoking for patients. A centralized program run by a NP with an oncology background can alleviate these issues while providing quality evidence based care. Vision: Advance practice providers in oncology are uniquely positioned to provide lung cancer screening. Our holistic approach to care, focusing on disease prevention and health promotion allows us to guide the patient through a potentially stressful screening process. The Thoracic NP meets with patients for the shared decision making visit and orders the CT. The NP directly follows up with patients for results, and manages all incidental findings, subsequent diagnostic procedures, referrals to specialty care while ensuring close communication with referring providers. The NP has access to weekly multidisciplinary thoracic conference to discuss significant findings and provides all longitudinal follow up regarding lung cancer screening. Programmatic Challenges: Lung cancer screening programs face a variety of challenges requiring collaboration of multiple departments including billing, registration, radiology, information technology, and marketing. Extensive PCP education is required on screening guidelines, including buy-in for referring patients to the screening clinic. Other challenges include complex reimbursement and documentation processes, design and implementation of patient tracking software options and education of insurance providers. Conclusion: The development and implementation of our screening program has been a valuable learning experience. To date we have screened 21 patients, one of which was found to have a squamous cell lung cancer. While our program is still new, we expect our volumes to grow over the next year as we continue to market our program in the region directly to patients and PCPs. We anticipate that our patient and provider satisfaction scores for this program will be high due to the expertise of our thoracic oncology nurse practitioner.
