Practice facilitation was feasible and acceptable in rural primary care clinics, modestly improving lung cancer screening order rates from 16-40% at baseline to 24-45% post-intervention.
Does practice facilitation improve lung cancer screening uptake in rural primary care clinics?
Practice facilitation is a feasible and acceptable strategy that modestly improves lung cancer screening order rates in rural primary care clinics.
Abstract Rationale Lung cancer screening saves lives, as demonstrated in multiple randomized trials of low-dose chest computed tomography. However, uptake remains low, less than 20% in the United States. Implementation has been slowed by burdensome reimbursement requirements, difficulty identifying eligible persons, and low levels of awareness. Practice Facilitation is an established implementation strategy that has been used to improve adherence to other screening guidelines in primary care. Methods We piloted practice facilitation in 6 rural Minnesota clinics. The Practice Facilitation pilot was conducted through a series of 8 interactions with a core implementation team in each clinic. The core components of practice facilitation were audit and feedback, education, Plan-Do-Study-Act cycles, and written resources for clinicians and patients. While each clinic received the same educational curriculum and written resources, the PDSA cycles were unique to the barriers and facilitators identified in each clinic. The intervention occurred from August 2024 to October 2025. The primary objectives of this study were feasibility and acceptability. Secondary outcomes included shared decision making, LDCT order rate and LDCT completion rate, which were calculated in each clinic at baseline, during, and after completion of the intervention. All rates were calculated at the clinic level using the denominator of “likely eligible” patients seen in the clinic in the last 3 months. Likely eligible patients were aged 50-80 and reported either current smoking status OR former smoking status with quit time less than 15 years, and max smoking years or pack-years more than 20. Results Practice facilitation as an implementation strategy was feasible and acceptable in six rural primary care clinics based in one of two large integrated healthcare delivery systems. Multi-level clinic staff participated in the intervention and all planned sessions were completed. Most clinics completed the intervention in the intended timeline with nearly all sessions conducted virtually. Clinics improved their LCS order rate modestly, with baseline rates from 16 - 40% and post-intervention rates from 24-45%. Conclusions Practice facilitation is feasible and acceptable in rural primary care clinics. Although primary care providers are aware of LCS, few other clinic staff are. Most clinics preferred remote sessions, which improves the feasibility and economic impact of adopting practice facilitation as an implementation strategy. Involving non-PCP staff in primary care clinics has the potential to improve LCS uptake through the same team-based approach used for most maintaining high rates of other cancer screening service uptake. This abstract is funded by: Minnesota Cancer Clinical Trials Network
Begnaud et al. (Fri,) conducted a other in Lung cancer screening uptake. Practice facilitation vs. Baseline was evaluated on Feasibility and acceptability. Practice facilitation was feasible and acceptable in rural primary care clinics, modestly improving lung cancer screening order rates from 16-40% at baseline to 24-45% post-intervention.