Planning and Implementation of Low-dose Computed Tomography Lung Cancer Screening Programs in the United States

Rebecca Qiu, BSN, RN; Amy Copeland, MPH; Erica Sercy, MSPH; Nancy R. Porter, MS; Karen Kane McDonnell, PhD, RN, OCN; Jan Marie Eberth, PhD


Clin J Oncol Nurs. 2016;20(1):52-58. 

In This Article


The current study used a mixed-methods research design. The quantitative component of the design involved a survey distributed by the Lung Cancer Alliance (LCA)—a national nonprofit advocacy and support organization—to contacts within its network of Screening Centers of Excellence (N = 90). These centers (LCA, 2014) are designated as Screening Centers of Excellence based on their attestation to the principles of the National Framework for Excellence in Lung Cancer Screening and Continuum of Care, including following best practice screening process guidelines, two of which are working with multidisciplinary treatment teams and offering smoking cessation counseling. The survey's purpose was to learn about the sites, components of their screening programs, costs, and barriers faced and resources that would have been useful in program planning. The electronic survey, distributed via SurveyMonkey®, was comprised of multiple-choice and open-ended questions. A reminder email was sent 10 days after the initial invitation to increase the survey response rate. Descriptive statistics were computed from the survey results using SAS®, version 9.3.

The qualitative portion of the research design gathered additional details about planning and barriers faced by LDCT screening programs. The University of South Carolina partnered with the LCA to interview clinical representatives from Screening Centers of Excellence. In the fall of 2013, two emails invited center representatives to participate in in-depth interviews, followed by additional recruiting through personal networks to obtain a geographically diverse participant pool. An interview guide was created and used to standardize the interview process. During telephone interviews, participants described their program's development, start-up and current barriers, cost of screening, insurance reimbursement, eligibility criteria, and screening guidelines. Thirteen nurse navigators and physicians completed the in-depth interview. Interviews lasted 10–30 minutes and were recorded with participant consent.

After transcribing the recordings, the research team separately coded the transcripts for themes using a grounded theory approach, in which data were collected to generate rather than test hypotheses (Mills, Bonner, & Francis, 2006). After comparison of the transcripts, the research team agreed on a final set of themes and recoded the transcripts accordingly. This study was submitted to the University of South Carolina Institutional Review Board and did not meet the review criteria for human participants research based on the organizational nature of the survey and interview questions.