Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Elizabeth Tovar

Clinical Mentor

Jessica Sass

Committee Member

Dr. Lynne Jensen


BACKGROUND: In 2018, there were approximately 234,030 new lung cancer diagnoses and 154,500 lung cancer deaths in the United States. Kentucky leads the nation in new lung cancer cases each year. The USPSTF estimates that 10% to 12% of lung cancers detected by routine screening would not have been detected until the cancer advanced; therefore, the USPSTF recommends yearly lung cancer screenings using low dose CT (LDCT) scans of the chest for patients 55 to 80 years old who have a 30 pack-year smoking history and are currently smoking or have quit within the last 15 years.

PURPOSE: The purpose of this project was to increase smoking history documentation, including pack-years, and LDCT orders for patients 55 to 80 years old who meet screening criteria in a primary care setting.

METHODS: The FOCUS-PDSA model for improvement was used to guide this quality improvement project. Four PDSA cycles using variations of prompts for screening (eg. lung cancer screening flyers and smoking history stickers on patient intake document) were conducted to identify the best strategies for increasing smoking history documentation, including pack-years and increasing LDCT orders. Retrospective and prospective chart reviews were completed for smoking history documentation and LDCT orders before and after the interventions.

RESULTS: There were no significant differences in each PDSA cycle for smoking history documentation (p=0.64) or LDCT orders (p=0.44). PDSA cycles one, two, and four showed a non-significant increase in documentation and orders. Current smokers were more likely to receive LDCT orders than former smokers who met eligibility criteria (p=0.05).

CONCLUSIONS: Findings suggest that reminders like, educational lung cancer screening flyers, and smoking history stickers could increase documentation and LDCT scan orders. More research is needed comparing lung cancer screening orders between current and former smokers.