Lung Cancer Screening Patients Experiences and Satisfaction: Quantitative and Qualitative Findings From a Survey Study

ABSTRACT

Introduction: In 2015, H. Lee Moffitt Cancer Center & Research Institute (MCC) launched a lung cancer screening program for high-risk individuals based on National Comprehensive Cancer Network guidelines. To identify successes and barriers of this program from the patient perspective, we conducted a survey study to measure patient experiences and satisfaction with lung cancer screening. Methods: In August 2020, a survey and cover letter were mailed to 576 patients who completed one or more lung cancer screenings at MCC. In addition to demographics, smoking history, and impact of the COVID-19 pandemic to get screened, the survey included 34 quantitative questions using a 5-point Likert scale and six open-ended questions. The quantitative questions measured patient satisfaction and experiences across 6 domains appointment process, clinical staff interactions, communication, visit with the provider, screening results, cost, and clinic facility/overall satisfaction. Results were quantified using descriptive statistics. The six open-ended items elicited barriers and facilitators related to returning for screening, experiences with other cancer screenings, positive and negative experiences with the low-dose computed tomography (LDCT) visit, and suggestions for improving the process of LDCT screening visits. Content analysis using the constant comparison method was applied to the text and coded based on the a priori codes of the open-ended questions. Results: Among the 212 patients (37% completion rate) who completed the survey, 97.6% were white, 48.6% were female, and the mean age was 69 years. In the communication domain, 81.1% “strongly agreed/agreed” that the lung cancer screening process was clearly explained, 92.5% “strongly agreed/agreed” that the potential harms and limitations were clearly explained and 76.9% “strongly agreed/agreed” that the process for follow-up screening was clearly explained. For the provider questions, 71.7% “strongly agreed/agreed” that the provider was willing to listen carefully and 68.4% “strongly agreed/agreed” that the instructions were easy to understand. For results and costs, 78.3% “strongly agreed/agreed” the screening results were clearly explained and 70.8% “strongly agreed/agreed” that the cost of the screening was justified. Regarding overall satisfaction, 88.2% “strongly agreed/agreed” they would recommend lung cancer screening at MCC. Patients who had Medicare insurance or paid out-of-pocket had higher agreement about helpfulness of the staff who assisted them with billing or insurance compared to patients who had private insurance coverage (79.4% Medicare coverage, 60.0% private, and 75.0% self-pay P-value=0.025). In the qualitative findings, respondents provided generally positive comments about their lung cancer screening experience. Negative comments were related to desire for more information about results, long wait times for results, and billing issues. Conclusions: This study provided insights about patient experiences and satisfaction with lung cancer screening which are important, given the low uptake of this life-saving modality. Ongoing patient-centered feedback may improve the lung cancer screening experience and increase follow-up screening rates. Keywords survey, screening, patient satisfaction