Patterns and Factors Associated With Adherence to Lung Cancer Screening in Diverse Practice Settings.
Patterns and Factors Associated With Adherence to Lung Cancer Screening in Diverse Practice Settings.
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DOI：
10.1001/jamanetworkopen.2021.8559
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发表时间：
2021-04-01
影响因子：
13.8
通讯作者：
Henderson LM
中科院分区：
文献类型：
--
作者：
Sakoda LC;Rivera MP;Zhang J;Perera P;Laurent CA;Durham D;Huamani Velasquez R;Lane L;Schwartz A;Quesenberry CP Jr;Minowada G;Henderson LM
在不同的实践环境中，与坚持每年进行肺癌筛查相关的模式和因素是什么？在这项队列研究中，总体而言，每年筛查的依从性并不理想，但通过集中式计划与分散式计划进行筛查的个体的依从性较高。与依从性相关的另一个重要因素是年龄。这项研究表明，集中筛查计划有助于提高每年肺癌筛查的依从性；需要进一步努力提高依从性，以实现与肺癌筛查相关的死亡率效益。为了使肺癌筛查能够降低死亡率，坚持每年进行低剂量计算机断层扫描筛查至关重要。尽管全国肺部筛查试验的依从率为 95%，但目前关于美国不同实践环境中筛查依从性的数据有限。评估基线检查阴性后与每年肺癌筛查依从性相关的模式和因素，特别是在集中与分散筛查计划中。这项观察性队列研究在北卡罗来纳州和加利福尼亚州的 5 个学术和社区中心进行，纳入了 2283 名在 2014 年 7 月 1 日至 2018 年 3 月 31 日期间接受肺癌筛查的个体，这些个体符合美国预防服务工作组的资格标准，基线筛查检查结果为阴性（美国放射学会肺部影像报告和数据系统 1 类或 2 类），并且有资格在 12 个月内返回进行筛查检查。为了确定与依从性相关的因素，使用多变量逻辑回归估计了依从性与选定的基线人口统计和临床特征（包括筛查计划的类型）的关联。如果个人通过肺癌筛查诊所或计划转介，则筛查计划类型被分类为集中；如果个人直接由临床医生转介进行基线低剂量计算机断层扫描，则筛查计划类型被分类为分散。遵守年度肺癌筛查，定义为基线筛查后 11 至 15 个月内进行第二次低剂量计算机断层扫描。在基线筛查结果为阴性的 2283 名符合条件的个体（1294 名男性 [56.7%]；平均 [SD] 年龄，64.9 [5.8] 岁；1160 名 [50.8%] 年龄≥65 岁）中，总体依从性为 40.2% (n = 917)，其中通过集中筛查接受筛查的患者依从性较高（46.0% [478] 1039]）与去中心化（35.3% [1244 中的 439]）计划。与依从性最密切相关的独立因素是筛查计划的类型，集中筛查相关的依从性可能性增加了 2.8 倍（调整后的比值比 [aOR]，2.78；95% CI，1.99-3.88）。另一个相关因素是年龄（65-69 岁与 55-59 岁：aOR，1.38；95% CI，1.07-1.77；70-74 岁与 55-59 岁：aOR，1.47；95% CI，1.10-1.96）。基线检查结果呈阴性后，每年肺癌筛查的依从性并不理想，尽管通过集中计划筛查的个体依从性较高。这些结果支持了集中筛查计划的价值，以及进一步实施提高肺癌年度筛查依从性的策略的必要性。该队列研究评估了基线检查阴性后坚持每年肺癌筛查的模式和因素，特别是在集中与分散筛查计划中。
What are the patterns and factors associated with adherence to annual screening for lung cancer across diverse practice settings? In this cohort study, adherence to annual screening was suboptimal overall but was higher among individuals who were screened through centralized vs decentralized programs. The other significant factor associated with adherence was age. This study suggests that centralized screening programs facilitate greater adherence to annual screening for lung cancer; further efforts to improve adherence need to be adopted to realize the mortality benefit associated with lung cancer screening. For lung cancer screening to confer mortality benefit, adherence to annual screening with low-dose computed tomography scans is essential. Although the National Lung Screening Trial had an adherence rate of 95%, current data are limited on screening adherence across diverse practice settings in the United States. To evaluate patterns and factors associated with adherence to annual screening for lung cancer after negative results of a baseline examination, particularly in centralized vs decentralized screening programs. This observational cohort study was conducted at 5 academic and community-based sites in North Carolina and California among 2283 individuals screened for lung cancer between July 1, 2014, and March 31, 2018, who met US Preventive Services Task Force eligibility criteria, had negative results of a baseline screening examination (American College of Radiology Lung Imaging Reporting and Data System category 1 or 2), and were eligible to return for a screening examination in 12 months. To identify factors associated with adherence, the association of adherence with selected baseline demographic and clinical characteristics, including type of screening program, was estimated using multivariable logistic regression. Screening program type was classified as centralized if individuals were referred through a lung cancer screening clinic or program and as decentralized if individuals had a direct clinician referral for the baseline low-dose computed tomography scan. Adherence to annual lung cancer screening, defined as a second low-dose computed tomography scan within 11 to 15 months after baseline screening. Among the 2283 eligible individuals (1294 men [56.7%]; mean [SD] age, 64.9 [5.8] years; 1160 [50.8%] aged ≥65 years) who had negative screening results at baseline, overall adherence was 40.2% (n = 917), with higher adherence among those who underwent screening through centralized (46.0% [478 of 1039]) vs decentralized (35.3% [439 of 1244]) programs. The independent factor most strongly associated with adherence was type of screening program, with a 2.8-fold increased likelihood of adherence associated with centralized screening (adjusted odds ratio [aOR], 2.78; 95% CI, 1.99-3.88). Another associated factor was age (65-69 vs 55-59 years: aOR, 1.38; 95% CI, 1.07-1.77; 70-74 vs 55-59 years: aOR, 1.47; 95% CI, 1.10-1.96). After negative results of a baseline examination, adherence to annual lung cancer screening was suboptimal, although adherence was higher among individuals who were screened through a centralized program. These results support the value of centralized screening programs and the need to further implement strategies that improve adherence to annual screening for lung cancer. This cohort study evaluates patterns and factors associated with adherence to annual screening for lung cancer after negative results of a baseline examination, particularly in centralized vs decentralized screening programs.
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DOI：
10.1164/rccm.202008-3053st
发表时间：
2020-10-01
影响因子：
24.7
作者：
Rivera MP;Katki HA;Tanner NT;Triplette M;Sakoda LC;Wiener RS;Cardarelli R;Carter-Harris L;Crothers K;Fathi JT;Ford ME;Smith R;Winn RA;Wisnivesky JP;Henderson LM;Aldrich MC
通讯作者：
Aldrich MC
影响因子：
33.9
作者：
Richards, Thomas B.;Soman, Ashwini;Richardson, Lisa C.
通讯作者：
Richardson, Lisa C.
影响因子：
39.2
作者：
Moyer, Virginia A.
通讯作者：
Moyer, Virginia A.
DOI：
10.1016/j.jacr.2019.08.010
发表时间：
2020-02
期刊：
Journal of the American College of Radiology : JACR
影响因子：
--
作者：
Spalluto LB;Lewis JA;LaBaze S;Sandler KL;Paulson AB;Callaway-Lane C;Grogan EL;Massion PP;Roumie CL
通讯作者：
Roumie CL
影响因子：
3.8
作者：
Lake, Michael;Shusted, Christine S.;Barta, Julie A.
通讯作者：
Barta, Julie A.