• Jennifer A Lewis, Lauren R Samuels, Jacy Weems, Daniel Park, Robert Winter, Christopher J Lindsell, Carol Callaway-Lane, Carolyn Audet, Christopher G Slatore, Renda Soylemez Wiener, Robert S Dittus, Sunil Kripalani, David F Yankelevitz, Claudia I Henschke, Drew Moghanaki, Michael E Matheny, Timothy J Vogus, Christianne L Roumie, and Lucy B Spalluto.
• VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Medical Service, VA Tennessee Valley Healthcare System, Veterans Health Administration, Nashville, Tennessee; Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee. Electronic address: jennifer.a.lewis@vumc.org.
• Am J Prev Med. 2023 Nov 1; 65 (5): 844853844-853.

IntroductionLung cancer screening is widely underutilized. Organizational factors, such as readiness for change and belief in the value of change (change valence), may contribute to underutilization. The aim of this study was to evaluate the association between healthcare organizations' preparedness and lung cancer screening utilization.MethodsInvestigators cross-sectionally surveyed clinicians, staff, and leaders at10 Veterans Affairs from November 2018 to February 2021 to assess organizational readiness to implement change. In 2022, investigators used simple and multivariable linear regression to evaluate the associations between facility-level organizational readiness to implement change and change valence with lung cancer screening utilization. Organizational readiness to implement change and change valence were calculated from individual surveys. The primary outcome was the proportion of eligible Veterans screened using low-dose computed tomography. Secondary analyses assessed scores by healthcare role.ResultsThe overall response rate was 27.4% (n=1,049), with 956 complete surveys analyzed: median age of 49 years, 70.3% female, 67.6% White, 34.6% clinicians, 61.1% staff, and 4.3% leaders. For each 1-point increase in median organizational readiness to implement change and change valence, there was an associated 8.4-percentage point (95% CI=0.2, 16.6) and a 6.3-percentage point increase in utilization (95% CI= -3.9, 16.5), respectively. Higher clinician and staff median scores were associated with increased utilization, whereas leader scores were associated with decreased utilization after adjusting for other roles.ConclusionsHealthcare organizations with higher readiness and change valence utilized more lung cancer screening. These results are hypothesis generating. Future interventions to increase organizations' preparedness, especially among clinicians and staff, may increase lung cancer screening utilization.Published by Elsevier Inc.

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