Population Health Nurse–Driven Lung Cancer Screening

Despite evidence supporting lung cancer screening (LCS) with low-dose computed tomography imaging, LCS rates remain as low as 5% nationally. Many barriers to screening have been identified, including but not limited to the following: competing priorities in the medical visit, lack of documentation of robust smoking histories, absence of clinical decision support for primary care teams, patient and provider knowledge gaps, and challenges with access to screening. To address these barriers, the authors piloted a patient-centered population health nurse–driven LCS intervention in a general internal medicine practice embedded in an urban safety-net health system. The intervention, which began in August 2022, included prescheduled nurse telehealth visits focused on cancer screening opportunities, a patient registry, and with standardized documentation templates, customized decision support tools to clarify eligibility and direct scheduling workflows at the time of the nurse visit. Empowering the nurse to take a more prominent role, working at the top of their license, to provide formal LCS shared decision-making represents an innovation to the care delivery model. In addition, this model improves on licensed independent practitioner–driven screening as the population health nurse directly schedules the LCS in the radiology schedule, reducing friction in the process. As of December 18, 2023, early experience shows that the pilot program achieved a 58.7% screening completion rate, suggesting that a nurse-driven model can contribute positively to the uptake of LCS.