ANAHEIM, CALIFORNIA—A lung screening service was implemented to care for persons at high risk for lung cancer. After a patient undergoes low-dose computed tomography (CT), a nurse practitioner (NP) meets the patient on the same day to discuss scan results and follow-up recommendations. A report on this program was presented at the Oncology Nursing Society (ONS) 39th Annual Congress.
Results from the National Lung Screening Trial criteria indicated that lung cancer mortality is reduced by 20% in persons at high risk who are screened with low-dose CT. So, the Thoracic Service Line at Fox Chase Cancer Center in Philadelphia, Pennsylvania, developed a lung screening service to provide low-dose screening CT and opportunities for education and referral.
Kristen Kreamer, MSN, CRNP, AOCNP®, ANP, BC, and colleagues led a multidisciplinary team consisting of a nurse practitioner, a nurse navigator, a nursing service line administrator, and physician colleagues in developing a lung screening service. A business plan was developed, and financial analysis was obtained to include billing and coding. The plan included a prescreening algorithm that the nurse navigator used when interacting with self-referred patients.
Kreamer noted that this program is unique in that patients receive their scan results on the same day. The NP meets with the patient to explain why screening may be needed, and its potential benefits, harms, and limitations. In particular, the NP explains the ambiguity of indeterminate results.
The meeting is a chance to increase awareness about the harms of smoking and help smokers learn of available smoking cessation programs, explained Kreamer. If the person signs the consent form, CT screening is done right away. An agreement with the radiology service ensures that the screens are read within 1 hour. The NP also provides follow-up recommendations.
The lung screening service had 28 self-referred patients in 2013; however, 16 did not meet the participation criteria because of insufficient smoking history, age, or a prior cancer diagnosis. Screening and triage occurred for 12 patients, with seven scheduled to return the following year, three in 6 months, one in 3 months, and one patient had metastatic lung cancer. In 2014, publicity and marketing efforts increased self-referrals and 17 people who met the screening criteria were serviced by the lung screening service.
Future plans include extending the age to persons 80 years old, and to those with a history of cancer but are not currently followed with CT.
Kreamer K, Edmondson D, Keeley P, Vadseth C. Success story: The nurses’ role in development and execution of a lung screening service for individuals at high risk for lung cancer. Presented at: Oncology Nursing Society (ONS) 39th Annual Congress; May 1-4, 2014; Anaheim, CA.
Prepared by Kathy Boltz, PhD, and Joyce Pagán