Date of Completion
Summer 2026
Document Type
DNP Scholarly Project
Academic Department
School of Nursing
Degree Type
Doctoral
Degree Name
Doctor of Nursing Practice
Abstract
Problem: Lung cancer is the leading cause of cancer-related deaths worldwide and is frequently diagnosed at advanced stages when treatment options are limited. A Veterans Administration (VA) primary care clinic demonstrated lower referral rates to the lung cancer screening (LCS) program than a comparable VA clinic despite having a higher prevalence of tobacco users. Existing electronic health record reminders focused on smoking cessation and did not systematically assess eligibility for LCS, contributing to underutilization of the screening program.
Aim of the Project: The aim of this quality improvement project was to increase referrals to the LCS program by improving identification of veterans eligible for screening through implementation of a standardized tobacco use history assessment tool.
Review of the Evidence: Evidence demonstrated substantial gaps between veterans eligible for LCS and those receiving screening. Literature supported the use of standardized tobacco use documentation and systematic screening processes to improve identification of eligible patients, increase referrals, and support earlier detection of lung cancer.
Project Design: The project utilized the Plan-Do-Study-Act (PDSA) framework to guide implementation, evaluation, and workflow refinement. The OhioHealth Change Management Model supported stakeholder engagement, readiness assessment, communication, and adaptation of workflow processes throughout implementation.
Intervention: A tobacco use history assessment tool based on United States Preventive Services Task Force screening criteria was incorporated into routine clinical workflow. Licensed practical nurses completed the tool during patient encounters, providers reviewed eligibility, and referrals were submitted for veterans who met screening criteria.
Significant Findings/Outcomes: During the eight-week implementation period, referrals to the LCS program increased from 10 baseline referrals to 87 referrals, representing a 770% increase. A total of 102 tobacco use history assessment tools were completed, and 93 were completed accurately, resulting in an accuracy rate of 91.18%, exceeding the project benchmark of 90%.
Implications for Nursing: Standardized tobacco use assessment improved identification of veterans eligible for LCS and increased referrals to preventive screening services. Integration of evidence-based screening tools into nursing workflows supports consistent risk assessment, strengthens interdisciplinary collaboration, and promotes early detection of lung cancer among high-risk veterans.
Recommended Citation
Randall, Megan, "Increasing Referrals to the Lung Cancer Screening Program" (2026). Doctor of Nursing Practice (DNP) Scholarly Project. 62.
https://fuse.franklin.edu/dnp-project/62
Rights
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