Abstract Introduction Approximately 1.5 to 2.4 million lung cancer screening (LCS) exams are performed annually in the US, often revealing unrelated incidental findings (IF), which prompts downstream testing and treatments, despite limited research on early disease states and their clinical implications. Management frequently falls to primary care providers (PCPs). The ATS research agenda on LCS and IF identified clinicians’ attitudes and preferences toward reporting of IFs as a research gap. We aimed to understand how Veterans Affairs (VA) PCPs manage IFs and their impact on workflow. Methods The survey was developed iteratively with the VA Lung Precision Oncology Program lung cancer screening sub-working group and VA PCPs. Demographics, including training and practice years, were collected. Three clinical vignettes (coronary artery calcifications (CAC), emphysema, and pulmonary fibrosis) were used to assess management and perspectives on the priority of IFs. The survey was administered electronically through RedCap to the National VA Primary Care Leadership, who then distributed it to local PCPs. We used descriptive statistics to characterize responses. Results 618 PCPs responded to this survey. After excluding 58 participants due to incomplete data, 560 respondents were included. 64% were physicians, 36% were APPs/NPs; 65% practiced independently for over 10 years, and 59% in the VA for over 5 years (Table). Respondents represented all Veterans Integrated Service Network (VISNs). 70% prefer non-emergent IFs to be reported in the body and impression of the radiology report, while the minority favor direct notifications electronic (5%); phone (2%). 39.8% consider any degree of CAC as significant, while 39.7% consider only moderate-severe CAC as significant. Any degree of emphysema and pulmonary fibrosis was considered significant by 41% and 68%, respectively. Providers preferred that IFs be reported on both baseline and follow-up scans (68% for CAC, 68% for emphysema, and 75% for fibrosis). Most respondents prefer IFs reported in the body and final impression of the radiology report (74% for CAC, 78% for emphysema, and 85% for fibrosis). Conclusions This large survey of PCPs in the US’s largest integrated healthcare network begins to address a research gap in understanding clinicians’ attitudes toward IFs. Perceptions of clinical significance vary based on the IF and its severity. Most PCPs prefer non-emergent IF in radiology reports for all screening studies, not just the baseline, as per the American College of Radiology. Future studies are necessary to improve the reporting of IF and understand the management implications of early detection of these conditions. This abstract is funded by: None
Bollam et al. (Fri,) studied this question.