How to Use the Guide
The American Thoracic Society and the American Lung Association joined forces to develop a guide for implementation of lung cancer screening (LCS) programs. The aim of this document is to provide a pragmatic guide and toolkit of how to design, implement, and conduct an LCS program based on a survey of experts in LCS representing a diversity of institutions throughout the United States. Members from the American Lung Association and American Thoracic Society known for their involvement in LCS activities, were selected to participate in the project. A panel of experts in the areas of research, behavioral sciences, quality improvement, nurse navigation, patient advocacy and clinicians involved in leading and performing lung cancer screening in the fields of pulmonary, radiology, interventional pulmonary, primary care, oncology, and thoracic surgery was assembled. The panel developed a document using information gathered from a clinical practice survey that aimed to address how participating members approached common problems encountered in clinical LCS and program implementation. This is not a guideline or position statement of the American Lung Association or the American Thoracic Society.
The panel reached consensus for the document to be formatted in question and answer format. Participants were polled for questions they are commonly asked by others performing or contemplating performing screening services. Questions were pooled together and organized under three categories. Members and questions were divided into one of the three working groups and questions distributed for answers. All members were given an opportunity to respond to every question. Not all participants responded to all questions and for some questions several gave the same response, which was indicated. The survey addresses practice approaches to challenges in LCS for which guideline or consensus statements may not exist. There are a variety of different screening models in practice today and therefore different responses are provided within this document. Some of the approaches are different and some may be in apparent conflict. No attempt was made to reach consensus on approaches because the goal was to report on actual practice patterns from diverse settings. Responses from individual members were collated and presented at an all-group in-person meeting. Following an initial draft, a second in-person meeting of several panel members took place resulting in this implementation guide for LCS programs.
The survey is meant to allow individuals to search specific participant responses. For example, if a reader’s center is most similar in organizational structure to a center like Cleveland Clinic, then the Cleveland Clinic responses are available for that reader to implement. Other centers may be more interested in the Kaiser responses, or the VA responses. This is why we have structured the document in this fashion. The responses are the viewpoints of the authors only and NOT reflective of the entire organization. The document is not meant to be read cover to cover, but rather for individuals to skip around to specific sections as they are tackling a particular issue along the course of their program development. Page numbers for the various sections allow this sort of usability, and ultimately the website will facilitate this functionality at a higher level.
Key summary recommendations are not possible in a practice survey such as this as some responses may be in contradiction to others. The reason for the survey format is to specifically avoid making summary recommendations as there are currently no available agreed upon screening quality metrics to allow comparisons across screening methods to state that one method is superior to another.