Nurse Practitioner Knowledge, Attitudes, and Practices Regarding Lung Cancer Screening in the United States

Sunday, 30 July 2017

Karen Kane McDonnell, PhD, MSN1
Amy C. Dievendorf, DNP1
Jan M. Eberth, PhD2
Erica Sercy, MSPH2
Deborah Warden, MSN1
Lauren Blew1
(1)College of Nursing, University of South Carolina, Columbia, SC, USA
(2)Arnold School of Public Health, University of South Carolina, Columbia, SC, USA


Lung cancer is a leading cause of cancer morbidity and mortality among men and women in the United States. Lung cancer is usually diagnosed during its most advanced stage, resulting in a dismal 17% five-year survival rate (Siegel, Miller, & Jemal, 2016). However, recent results from the National Lung Screening Trial (NLST) indicate the potential to detect lung cancer at earlier stages, thereby decreasing mortality. Low-dose computed tomography (LDCT) for lung cancer screening has been shown to reduce lung cancer-related mortality by 20% (Bach et al., 2012). Based on this new evidence and the development of practice guidelines, the United States’ Centers for Medicare & Medicaid Services (CMS) added lung cancer screening as a benefit for patients at risk for lung cancer, requiring counseling and a shared decision-making visit with a care provider and annual screening with LDCT (CMS, 2015). While lung cancer screening can save lives, very little is known about how it is perceived by primary care providers, and how those perceptions are translated into the practice setting. The required shared decision-making process between care providers and patients is also largely unexplored (Volk & Foxhall, 2015; Ersek et al., 2016; National Academy of Science, Engineering, and Medicine, 2016). This study is part of a larger survey including several types of primary care providers. The purpose of this study, now underway, is to examine knowledge, attitudes, and practices regarding lung cancer screening among nurse practitioners who work with high-risk patients in primary care settings.


A mixed methods design was used. A conceptual framework of barriers to screening guideline adherence, developed by Cabana et al. (2012), guided the development of the survey and data interpretation. The pre-tested paper survey was distributed to a random national sample of 3,000 nurse practitioners (NPs) self-identified as working in a primary care setting in the United States. A sequential explanatory method will use the quantitative survey data to inform development of questions for a qualitative interview. Audio-recorded interviews will be conducted over the telephone and transcribed by a professional service. Descriptive statistics will be the primary analysis approach. All quantitative analyses will be conducted using SAS®Procedures. Population-based estimates will be based on weighted calculations of completed survey responses. Weights will be applied to ensure that the sample is representative of age, gender, and geographic differences. Comparisons of primary care NPs’ knowledge, attitudes, or screening practices across sub-groups (e.g., practice setting, age range, gender, and race/ethnicity) will be made using Pearson’s chi-squared tests or t-tests, with associated tests of statistical significance. Standard multivariate linear and logistic regression will be used to analyze relationships between knowledge about and attitudes toward screening (independent variables) and screening practices (dependent variable). Thematic analysis processes outlined by Braun, Clarke and Terry (2015) will be used to analyze and identify common themes among the transcribed qualitative interviews.


Study findings will be used to inform the development and testing of educational interventions targeting identified knowledge gaps among NPs caring for high-risk patients in primary care settings, as well as, clinical interventions to facilitate shared decision-making relating to lung cancer screening. The results will provide researchers in other areas of lung cancer screening research with baseline data to develop and test patient-, provider- and systems-level interventions to increase awareness of and reduce barriers to lung cancer screening in clinical practice.


This is the first study to examine knowledge, attitudes, and practices regarding lung cancer screening of nurse practitioners who work in primary care settings. Results of this study will be used to support this research team’s efforts to secure additional funding to further develop this important program of research.