Perceived barriers and facilitators to improving lung cancer screening among primary care providers in an academic teaching hospital: A qualitative needs assessment.

Abstract

585 Background: Lung cancer screening (LCS) in eligible adults remains lower than for other cancers, despite advances in screening technology, such as artificial intelligence in computed tomography screening. Prior studies have identified patient-level barriers to LCS, including cost concerns and fear of diagnosis; however, provider perspectives remain limited. We conducted a qualitative needs assessment to characterize provider practices to identify barriers and facilitators to LCS in an academic primary care clinic. Methods: We conducted virtual semi-structured interviews exploring LCS counseling with primary care providers at the Randy Barker Medical Group Primary Care Clinic, Johns Hopkins Bayview Medical Center, from January to May 2026. Interview questions explored topics including eligibility identification, knowledge of LCS guidelines, counseling practices, perceived barriers and facilitators, and ordering workflow. Data was analyzed using thematic analysis. Codes were developed and iteratively refined through consensus discussions. De-identified transcripts were then independently coded by two study team members and discrepancies were resolved by a third reviewer. When coding was complete, codes were aggregated into thematic categories. Results: Seventeen providers participated, including residents (n=11), faculty (n=5), and advanced practice providers (n=1). Facilitators to LCS included general comfort initiating screening discussions, use of shared decision-making, and Epic care-gap alerts that prompted screening conversations. Barriers spanned multiple levels: at the encounter level, acute and chronic disease management often competed with LCS outside annual wellness visits and care-gap alerts were viewed as inconsistently accurate; at the provider level, uncertainty about eligibility criteria and limited formal training; at the patient level, inability to complete ordered screening driven by socioeconomic demands (work, caregiving, transportation) and smoking-related stigma. To address these, providers proposed enhanced EMR-based decision support, including accurate eligibility identification through standardized smoking history documentation, dashboards to track screening completion, population health outreach, and team-based scheduling workflows. Future work will evaluate the impact of these interventions on LCS completion rates. Conclusions: Provider-perceived barriers to LCS in this urban academic clinic span encounter-level constraints, knowledge gaps, and patient-level adherence challenges. Providers identified EMR-based decision support and team-based workflows as potential strategies to improve screening uptake. Future work will evaluate the impact of these EMR-based support tools on LCS completion rates.