Illustrative Quotes of Subtheme 1a, How Sick Is My Patient?
| Respondent | Quote |
|---|---|
| Respondent 1 | I have had patients of mine that have got way too much going on, they’re too fragile in their other competing priorities that I would shy away from a number of preventive measures that would involve any risk of preventing something else from getting done. |
| Respondent 3 | People who have other malignancies, pretty significant dementia, I guess I don’t usually bring it up. If they bring it up, I’m happy to talk about it with them, but [LCS is] not something I’m using [for these patients] right now. |
| Respondent 6 | If I were to go further and talk about the risk stratification … I guess, conditions would prevent me from asking [about LCS]. Okay, so if they’re already being treated for cancer, I’m not going to bring [LCS] up, because they’re already in that pipeline and screen all that, with a CT scan already, usually. If it is something like cardiac, like a stage IV congestive heart failure, I probably will not bring [LCS] up either. They’re on stage IV, right? Then their quality of life has already changed quite a bit, and they might be at higher risk. |
| Respondent 7 | Well, that’s a very difficult thing, but somebody with very advanced heart failure … dementia, people who are very basically bedbound and who are probably not going to be—I mean I actually have a patient with MS who’s been living for 10 years, but that’s unusual. She’s bedbound, but anyway, do I use any scores? No, but sometimes with people with ejection fractions of under 25%, who are basically barely getting out of the house and have a lot of readmissions to the hospital, I may not bring it up. |
| Respondent 9 | Yes [a patient’s comorbidities influence whether I recommend LCS]. If I have someone that’s got … stage 2 cancer in some other organ and undergoing treatment, I’m probably not going to recommend [LCS] at that point, or if it’s like one of those patients that has like—they’re on dialysis, they’ve had a liver transplant, they have like everything in the book, and they’re very complicated and they have a lot going on, and they see 20 different specialists, I may not. |
| Respondent 12 | Definitely [there are cases where LCS is not on my radar even if they are eligible]. Sometimes if I think a patient has many active issues currently going on, then I probably wouldn’t bring it up like right away. I probably would wait a little a bit. Like if they were in the middle of transitioning, like if they were getting a fistula in place, they can be on dialysis in the next few months, I would probably hold off from bringing it up. If they have like a big coronary event earlier in the year, and they’re still following up with their cardiologist very closely, I probably would wait a little bit. |
| Respondent 13 | Yes. I think I’m more concerned that they have some other much more—well, I’ve already defined significant morbidity and whatever the diagnosis is, whether it’s like a severe CHF, things like significant other issues that—bringing this up and it’s almost like we’ll revert them with something that may not at the end help them as much as it would have helped the person who didn’t have those. |
CT = computed tomography; CHF = congestive heart failure; LCS = lung cancer screening; MS = multiple sclerosis.