Date of Award

2025

Document Type

Doctor of Nursing Practice (DNP)

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

Committee Chair

Haley Hoy

Committee Member

Shikha Modi

Committee Member

Jonathan Hontzas

Subject(s)

Lungs--Cancer-Early detection, Older people--Medical examinations, Preventive health services

Abstract

In the United States (U.S.), lung cancer is the foremost contributor to cancer-related deaths. Tobacco use is associated with more than 80% of lung cancer diagnoses and the likelihood of developing lung cancer among long-term cigarette smokers increases as individuals age, placing many Medicare beneficiaries at heightened risk. Early detection of lung cancer dramatically improves outcomes for patients, but most cases are found at advanced stages when survival rates are worse. Many expert panels recommend annual low-dose chest computed tomography (LDCT) scans to screen high-risk individuals, yet LDCT remains underutilized in the Medicare population. Medicare beneficiaries who participate in annual wellness visits (AWVs) are more likely to receive recommended preventive services. This clinical practice change project was conducted at a medical center in the Southeastern U.S. and established a lung cancer screening protocol for primary care clinicians to use during Medicare AWVs to increase screening LDCT scans among eligible patients. The protocol was implemented after clinicians received targeted education regarding lung cancer screening guidelines and referral processes. The protocol was designed to aid clinicians in identifying at-risk Medicare beneficiaries for lung cancer. Clinicians used discrete data fields to document patient tobacco use history. A standardized note template was incorporated into AWVs to address lung cancer screening eligibility. Data were analyzed for three months before and after implementation. The analysis included a total of 861 AWVs. Following the educational session, survey data showed a significant improvement in clinicians’ knowledge and perspectives regarding lung cancer screening (Wilcoxon signed-rank test: Z = 2.032, p < 0.05). The quality of tobacco use documentation, referrals, and uptake of screening LDCT scans improved after the initiation of the protocol. These findings demonstrate the benefit of using a comprehensive lung cancer screening protocol during Medicare AWVs to identify at-risk patients and improve lung cancer screening utilization.

Available for download on Monday, February 01, 2027

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