We don't get that information right back to us unless it's a full-blown cancer - Challenges coordinating lung cancer screening across healthcare systems

Sep 21, 2026

Objective: Examine how lung cancer screening (LCS) is coordinated across healthcare systems, focusing on Veterans Affairs (VA) and non-VA settings. Methods: Primary qualitative data were collected in six VA medical centers (Nov 2020–Nov 2021) using semi-structured interviews with 48 primary care providers, LCS program staff, and pulmonologists. Thematic analysis mapped coordination challenges across the LCS care continuum. Results: Non-VA options increased LCS access, but VA sites lacked clear referral initiation and tracking processes when screening occurred outside VA care. Communication and data transfer gaps delayed post-screen evaluation of potentially cancerous nodules, fragmenting care quality. Conclusions: Policies expanding LCS access increase uptake, yet inconsistent cross-system processes for referrals, results, and timely downstream evaluation create unintended delays; strategies are needed to prevent Veterans from falling through gaps.

LanguageEnglish

CategoryHealthcare

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Pages9

Reading Time23 min

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Abstract

Objective

Data Sources and Study Setting

Study Design and Data Collection Methods

Principal Findings

Conclusions

Introduction

DOI: 10.1111/1475-6773.14384 RES EARCH A RTICLE Health Services Research “We don't get that information right back to us unless it's a full-blown cancer”: Challenges coordinating lung cancer screening across healthcare systems Rendelle E. Bolton PhD, MPH 1 | Eduardo R. Núñez MD 2,3 | Jacqueline Boudreau MPH 1 | Lauren M. Kearney MD 2,4 | Samantha K. Ryan MPH 2 | Abigail Herbst MPH 1 | Christopher Slatore MD 5,6 | Renda Soylemez Wiener MD, MPH 2,4,7 1VA Bedford Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA 2VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, Massachusetts, USA 3Department of Healthcare Delivery and Population Health Sciences, University of Massachusetts Chan Medical School – Baystate, Springfield, Massachusetts, USA 4The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, USA 5Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon, USA 6Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, Oregon, USA 7National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC, USA Correspondence Rendelle E. Bolton, VA Bedford Healthcare System, Center for Healthcare Organization and Implementation Research, 200 Springs Road, Bedford, MA 01730, USA. Email: [rendelle.bolton@va.gov](rendelle.bolton@va.gov) Funding information US Department of Veterans Affairs Health Services Research and Development, Grant/Award Number: IIR \#18-075 Abstract Objective: To examine how lung cancer screening (LCS) is coordinated across healthcare systems, specifically Veterans Affairs (VA) and non-VA settings. Data Sources and Study Setting: We conducted primary qualitative data collection in six VA medical centers with established LCS programs from November 2020 to November 2021 . Study Design and Data Collection Methods: Semi-structured interviews were conducted with 48 primary care providers, LCS program coordinators and directors, and pulmonologists. Thematic analysis examined spontaneously raised narratives related to initiating and coordinating LCS for Veterans screened in non-VA settings. We mapped coordination challenges to each step of the LCS care continuum. Principal Findings: While non-VA options increased access to LCS for Veterans, VA medical centers lacked clear processes for initiating LCS referrals and tracking Veterans across the LCS continuum when screening occurred in non-VA settings. The responsibility of coordinating LCS with community providers often fell to VA primary care providers rather than LCS programs. Gaps in communication and data transfer contributed to delayed evaluation of potentially cancerous nodules post-screening, raising concerns about compromised care quality when LCS was shared with non-VA settings. Conclusions: While policies expanding LCS for Veterans in non-VA settings increase access, lack of consistent processes to initiate referrals, obtain results, and promote timely downstream evaluation fragmented care and delayed evaluation of concerning nodules. These unintended consequences highlight a need to address cross-system coordination challenges. Strategies to better coordinate LCS between VA and nonVA settings are essential to achieve high quality LCS and prevent Veterans from falling through the cracks. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. Published 2024 . This article is a U.S. Government work and is in the public domain in the USA. Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust. Health Serv Res. 2025;6

FAQs

What problem does the study examine about lung cancer screening coordination?

It examines how lung cancer screening (LCS) is coordinated across healthcare systems, specifically comparing Veterans Affairs (VA) and non-VA settings.

How was the qualitative data collected and analyzed?

Semi-structured interviews were conducted with 48 primary care providers, LCS program coordinators/directors, and pulmonologists in six VA medical centers. Thematic analysis mapped challenges to each step of the LCS care continuum.

What were the main coordination gaps identified between VA and non-VA settings?

VA medical centers lacked clear processes to initiate LCS referrals and track Veterans across the continuum when screening happened in non-VA settings. Communication and data transfer gaps contributed to delays in post-screen evaluation of concerning nodules.

Sep 21, 2026

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