Lung cancer remains the leading cause of cancer-related mortality in the United States, yet profound advances in screening, diagnosis, treatment, and survivorship have redefined what is possible for patients. Despite this progress, nihilism, fatalism, and stigma continue to shape public and professional perceptions, discouraging screening and delaying help-seeking. Nurse practitioners occupy a central and trusted position across the lung cancer continuum and are uniquely equipped to counter these barriers through compassionate, stigma-informed communication. This perspective article synthesizes current evidence to illuminate how nurse practitioners can translate empathy, equity, and behavioral science into tangible practice actions that reduce stigma and nihilism and instill compassion and hope. Key strengths-language, empathy, tobacco treatment integration, social context awareness, community engagement, and hope-form the "Permission to Hope" framework. By leveraging these strengths, nurse practitioners can transform everyday interactions into opportunities to rebuild trust, improve screening participation, and redefine what survivorship means in lung cancer care.

Patient navigation programs have demonstrated intervention efficacy associated with barrier reduction and health outcome improvements in the context of cancer care. Greater characterization of barriers and barrier resolution likelihoods may support program optimization. A 3-month longitudinal, non-comparative community-focused (i.e., lay navigator) patient navigation program was implemented at an NCI-designed cancer center between 2018 and 2021. Barriers to cancer care were reported by patients (n = 207) at pre-intervention and re-assessed at post-intervention. Descriptive analyses examined patient-level associations among pre-intervention barriers and post-intervention rates of barrier resolution. Logistic regressions were conducted at the barrier level and patient level to estimate the likelihood of barrier resolution associated with Health Access, Financial, and Psychosocial barrier domains. Participants reported an average of 3.54 distinct barriers to cancer care. Barriers associated with Health Access and Financial domains were most frequently endorsed. Post-navigation, barriers were found to differ in their resolution rates. At the barrier domain level, resolution rates differed significantly (X2(2) = 7.826, p = 0.02), with Financial barriers significantly less likely (OR = 0.61; 95

Background: Lung cancer screening (LCS) with low-dose CT (LDCT) remains markedly underutilized. Prior studies suggest that perceptions regarding LCS may influence intention to undergo LDCT; however, little is known about these beliefs and behaviors in vulnerable populations. We examined LCS-related health beliefs and LDCT completion in an urban safety-net health care system. Patients and Methods: We surveyed English- and Spanish-speaking individuals between February 2017 and February 2019 who had been scheduled for, but had not yet undergone, an initial LDCT. Survey items were adapted from validated measures, including the Lung Cancer Screening Health Belief Scales and the Lerman Breast Cancer Worry Scales, to assess LCS-related beliefs and lung cancer-related worry. We examined associations between these factors and LDCT completion using 2-sample t tests and chi-square tests. Results: Among 447 eligible individuals, 411 participated in the survey (71% from racial/ethnic minoritized groups), of whom 339 (82%) completed the initial LDCT. Almost half believed that they were at risk for lung cancer in their lifetime, and >90% believed that LCS would help find lung cancer early. Higher self-efficacy scores and lower perceived barriers scores were associated with LDCT completion (P=.002 and P=.004, respectively). Perceived risk and benefit scores were not associated with LDCT completion. Individuals who did not complete the first LDCT were more likely to note fear of lung problems (33% vs 18%; P<.001), stigma related to lung cancer (33% vs 17%; P=.008), and worry affecting mood (77% vs 64%; P=.02). Conclusions: In a diverse, real-world LCS population, most patients believed that LCS facilitates early detection of lung cancer; however, approximately 20% did not complete the initial LDCT. Perceived fear, stigma, and negative emotional responses to a potential lung cancer diagnosis were associated with lower LDCT completion rates. These findings offer insight into potentially modifiable factors and future interventions to improve LCS uptake among eligible individuals.

BACKGROUND:Lung cancer stigma (i.e., perceived and internalized negative appraisal and devaluation associated with lung cancer) is a clinically significant psychosocial concern among individuals diagnosed with lung cancer. Stigma has been linked to increased psychological distress, higher depressive symptoms, anxiety, lower quality of life, and reduced engagement in care. However, few patient-centered interventions address lung cancer stigma. Mindful Self-Compassion (MSC) is a promising approach that promotes emotional resilience and reduces psychological distress. However, MSC has not been tailored for the needs of people with lung cancer. To address this gap, we developed Mindful Self-Compassion for Lung Cancer (MSC-LC)-a disease-specific adaptation designed to reduce stigma by cultivating self-compassion. This study aims to assess the feasibility, acceptability, and preliminary efficacy of MSC-LC among individuals with lung cancer who report elevated stigma. METHODS:Theoretically grounded in the Conceptual Model of Lung Cancer Stigma, the Health Stigma and Discrimination Framework, and the CDC Map of Adaptation, this pilot trial uses a parallel-group randomized controlled design (1:1 allocation) comparing MSC-LC to an enhanced standard-of-care waitlist control group (CTL). We aim to enroll 60 adults diagnosed with lung cancer (n=30 per condition) who exceed a validated cutoff for elevated stigma on the Lung Cancer Stigma Inventory. MSC-LC includes weekly 90-min virtual group sessions co-facilitated by trained interventionists and home practice assignments between sessions. Feasibility and treatment fidelity (primary outcomes) will be assessed using quantitative benchmarks (e.g., recruitment, retention, session attendance, interventionist adherence). Acceptability will be evaluated through qualitative interviews. Secondary outcomes including stigma, self-compassion, depressive symptoms, anxiety, and spiritual well-being will be collected at baseline, mid-intervention, post-intervention, and longer-term follow-up. Quantitative and qualitative data will be integrated at the interpretation phase to examine signals of change and inform refinement and implementation. DISCUSSION:This study will address the gap of patient-centered interventions that target the reduction of lung cancer stigma. Findings will inform the rigorous evaluation of the efficacy of MSC-LC to reduce stigma among individuals with lung cancer. TRIAL REGISTRATION:The protocol for this study has been registered on ClinicalTrials.gov (ID: NCT06191939). First posted December 20, 2023, last update posted July 17, 2025. https://clinicaltrials.gov/study/NCT06191939 .

Innovations across the lung cancer continuum, from risk reduction through end-of-life care, have transformed the lung cancer landscape, and are dramatically altering the trajectory of lung cancer outcomes. Although the lung cancer community has been infused with optimism and hope regarding these positive developments, persistent societal perspectives regarding lung cancer and the complex relationship with smoking have been substantially slower to change. These barriers constrain the implementation of innovative and effective care, and hinder progress toward reducing lung cancer incidence and mortality. To address the prevailing societal barriers, the American Cancer Society National Lung Cancer Roundtable (ACS NLCRT) launched the Survivorship, Stigma, and Nihilism Task Group (SSNTG) soon after the inaugural 2017 ACS NLCRT meeting. Engaging a diverse group of individuals and organizations with expertise in these cardinal domains, the SSNTG, which consisted of clinicians, advocates, and researchers representing different disciplines and experiences, convened to develop a strategic plan to improve lung cancer survivorship and eliminate lung cancer stigma and nihilism as essential components of achieving optimal lung cancer outcomes. The SSNTG established a trilateral mission and launched the Campaign to End Lung Cancer Stigma and other efforts to support lung cancer survivorship and address lung cancer-related nihilism and fatalism. This commentary highlights the multilayered work of the SSNTG, including (1) background justification for each of the three targeted areas, (2) active initiatives to reduce lung cancer stigma and nihilism and improve lung cancer survivorship, and (3) next steps that the task group plans to pursue to support the ACS NLCRT mission.

OBJECTIVE:Coping trajectories are important predictors of depressive symptoms among individuals with cancer. However, less is understood about the relationship between coping and depression within the context of psychosocial interventions, especially among minoritized (i.e. "underserved") populations. The current study addresses this gap by investigating the relationship between coping strategies and changes in depression severity among underserved cancer patients participating in the Collaborative Oncology Project to Enhance Depression Care (COPE-D), a 12-week collaborative care depression management intervention for patients with cancer. METHODS:The sample comprised 137 participants who completed both baseline and 12-week follow-up measures. Coping strategies were measured using a shortened version of the adapted Coping Orientation to Problems Experienced (COPE) Inventory, and depression severity was assessed using the Patient Health Questionnaire-9 (PHQ-9). Pre-intervention coping strategies were investigated as predictors of change in depression severity over the intervention, and changes in coping were investigated as moderators of the association between pre- and post-intervention depression severity. RESULTS:Participants reported significant increases in approach-oriented coping over the course of the intervention (t = 6.57, df = 140, p < 0.001). Conversely, participants exhibited a statistically significant decrease in avoidance-oriented coping (t = -2.76, df = 192, p = 0.006). Neither the degree of approach nor avoidant baseline coping strategies significantly predicted changes in depression severity over the course of the intervention. Changes in avoidance-oriented coping were associated with changes in depression severity (β = 0.2662, p = 0.0304) such that those who maintained or increased avoidant coping over time were less likely to report decreases in depressive symptoms. CONCLUSIONS:Baseline coping did not predict changes in depression severity during the intervention. However, increases in avoidance-oriented coping were associated with greater increases in depression severity over time. These findings underscore the importance of considering coping strategies in depression management interventions for cancer patients.

Introduction: Cancer survivors experience gaps in access to timely and well-coordinated care. We describe stakeholder engagement activities across a university-based comprehensive cancer center and a primary care-focused federally qualified health center, which informed implementation and sustainability of community-focused cancer care coordination interventions to optimize care for underserved cancer patients in specialty and primary care. Methods: Methods were systematic, iterative, and flexible to establish and maintain trust, honesty, and collaborative decision-making between academic, community, and clinical partners. First, we collaboratively identified clinical (N = 43) and patient (N = 16) stakeholders and their needs through in-depth interviews and focus groups. Then, we planned, implemented, evaluated, and modified strategies to improve cancer care coordination in response to challenges and new information. Results: Primary care providers reported needing more information about cancer survivorship care and wanting more complete information about their patients’ cancer treatment. Patients described concerns about cancer recurrence, challenges managing comorbid conditions, and economic concerns. These findings influenced the focus and implementation of a community navigation program at the academic cancer center and informed bi-directional information-sharing interventions with primary and oncology care partners, which included face-to-face meetings, service-learning opportunities, and improving data transmission through the electronic health record. Health Equity Implications: Health systems’ mutual learning and resource sharing enhance patient cancer care coordination to address social determinants of health. Engaging partners at different levels within health systems (e.g., administrative staff and clinical leadership) ensures sustainability of relationships, interventions, and advocacy for cancer patients with significant social needs.

OBJECTIVE:Contemporary stress-health theories posit that vigilance is a candidate biobehavioral process linking stress exposure to cardiovascular disease (CVD). We examined whether experimentally manipulated stress varying in vigilance demand would evoke hypothesized biobehavioral responses and whether persistent vigilance demand was matched by sustained physiological activation. METHODS:A final sample of 135 undergraduate young adults (49% male, 51% female; Mage =19 y, SD age =4 y) was randomized to 1 of 3 videogame task conditions (challenge, threat, neutral) with vigilant behavior demand. Blood pressure, impedance cardiography, and affect were measured during baseline, 30-minute gameplay, and recovery. RESULTS:Consistent with expectations, analysis of covariance (ANCOVA) models revealed that engaging in higher vigilance demand games (hypothesized to evoke both threat and challenge) resulted in significantly greater increases in blood pressure (BP) and heart rate (HR) than the neutral game ( F1,107 >8.60, p <0.001), especially in the threat condition. Threat condition participants also demonstrated the least recovery to baseline BP ( F1,106 >4.50, p <0.05). In addition, repeated measures ANCOVAs demonstrated persistent vigilance demand was matched by sustained cardiovascular activation throughout the 30-minute gameplay. CONCLUSIONS:Stress-related vigilance is associated with sustained vascular reactivity and slower recovery. These findings support behavioral vigilance as an ecologically valid behavioral path linking stress to CVD risk in daily life.

Background:Under-represented populations may have higher smoking rates and face greater risk of lung cancer. We examined perceptions of lung cancer risk and smoking behaviors in an urban safety-net lung cancer screening (LCS) population. Methods:We conducted surveys of English- and Spanish-speaking individuals undergoing first-time low-dose computed tomography (LDCT). Current smoking was defined as one or more cigarettes within the past month. We characterized smoking behavior according to the transtheoretical model of health behavior change. Results were analyzed by Chi-square test, Fisher's exact test, and multivariable logistic regression models. Results:Among 447 invited individuals, 411 (92%) participated in the survey, of whom 53% were Black, 18% were Hispanic, 56% reported income below the federal poverty level, 62% had graduated high school, and 79% were current smokers. Seventy percent reported some degree of worry about developing lung cancer, with 40% perceiving they were at risk in the next 10 years. In multivariable analysis, recent quit attempts were significantly associated with older age, Black race, perceived lung cancer risk in the next ten years, and level of worry about developing lung cancer. Specifically, individuals perceiving personal lung cancer risk were less likely to have made a recent quit attempt (OR 0.47; P = 0.04), while those reporting a lot of worry about developing lung cancer were more likely to have attempted to quit in the prior 12 months (OR 3.81; P = 0.001). Men (OR 1.71; P = 0.03) and Hispanic individuals (OR 3.87 compared to Black individuals; P < 0.001) were more likely to perceive personal risk of lung cancer. When grouped according to health behavior change (precontemplation/contemplation, preparation, action, maintenance), smoking behavior was not associated with level of worry about lung cancer (P = 0.46). Conclusions:In an urban, safety-net LCS population, current smoking rates are high and perceived lung cancer risk varies by numerous demographic characteristics. While most individuals reported worry about lung cancer, which correlated with past quit attempts, this concern is not associated with overall current smoking behavior. Given disparities in smoking rates and lung cancer risk, a nuanced understanding of factors affecting smoking behaviors may optimize cessation interventions in under-represented populations.

PURPOSEA single-arm trial evaluated the feasibility, acceptability, and outcomes of COPE-D, a collaborative care intervention for underserved cancer patients with depression.METHODSBilingual (Spanish and English) care managers provided counseling and/or medication management in consultation with physicians. Outcomes were treatment improvement (≥ 5-point reduction in PHQ-9), treatment response (≥ 50% reduction in PHQ-9), suicidal ideation resolution, and changes in depression (PHQ-9), anxiety (GAD-2), sleep disturbance (PSQI), global mental and physical health (PROMIS), social isolation (PROMIS), and qualitative feedback.RESULTS193 patients consented to participate. 165 initiated and 141 completed treatment, with 65% and 56% achieving treatment improvement and response, respectively. Outcomes did not differ by ethnicity (31% Hispanic), cancer stage (71% stages III-IV), income, or education. Suicidal ideation, depression, anxiety, sleep disturbance, and social isolation also improved. Qualitative feedback was largely positive.CONCLUSIONCOPE-D improved depression and quality of life among underserved patients, with acceptable retention rates.

BACKGROUND:Prior research demonstrates that nearly all (95 %) people with lung cancer (PwLC) report stigma, and approximately half (48 %) PwLC experience stigma during clinical encounters with oncology care providers (OCPs). When stigma is experienced in a medical context, it can have undesirable consequences including patients' delaying and underreporting of symptoms, misreporting of smoking behavior, and avoiding help-seeking such as psychosocial support and cessation counseling. Multi-level interventions are needed to prevent and mitigate lung cancer stigma. One promising intervention for reducing patient perception and experience of stigma is to train OCPs in responding empathically to patient emotions and promoting empathic communication within clinical encounters. METHODS:This paper describes the study protocol for a cluster randomized trial comparing Usual Care (waitlist control group) with Empathic Communication Skills (ECS) training (intervention group). For this study, we will recruit 16 community oncology practice sites, 9-11 OCPs per site, and 6 PwLCs per OCP. RESULTS:The goal of this trial is to investigate the effect of the ECS training on (a) OCP primary outcomes (communication and empathic skill uptake) and secondary outcomes (ECS training appraisal - relevance, novelty, clarity; self-efficacy, attitude towards communication with patients); and (b) patient-reported primary outcomes (lung cancer stigma), and secondary outcomes (perceived clinician empathy, satisfaction with OCP communication, psychological distress, social isolation, and appraisal of care). CONCLUSION:Findings from this trial will advance understanding of the effectiveness of the ECS training intervention and inform future provider-level training interventions that may reduce lung cancer stigma and improve cancer care delivery. CLINICALTRIALS:govIdentifier: NCT05456841.

Background: Although low-dose, CT -based lung cancer screening (LCS) can decrease lung cancer mortality in high-risk individuals, the process may be complex and pose challenges to patients, particularly those from minority underinsured and uninsured populations. We conducted a randomized controlled trial of telephone-based navigation for LCS within an integrated, urban, safety-net health care system. Patients and Methods: Patients eligible for LCS were randomized (1:1) to usual care with or without navigation at Parkland Health in Dallas, Texas. The primary endpoint was completion of the first 3 consecutive steps in a patient 's LCS process. We explored differences in completion of LCS steps between navigation and usual care groups, controlling for patient characteristics using the chi-square test. Results: Patients (N = 447) were randomized to either navigation (n = 225) or usual care (n = 222). Mean patient age was 62 years, 46% were female, and 69% were racial/ethnic minorities. There was no difference in completion of the first 3 steps of the LCS algorithm between arms (12% vs 9%, respectively; P = .30). For ordered LCS steps, completion rates were higher among patients who received navigation (86% vs 79%; P = .03). The primary reason for step noncompletion was lack of order placement. Conclusions: In this study, lack of order placement was a key reason for incomplete LCS steps. When orders were placed, patients who received navigation had higher rates of completion. Clinical team education and enhanced electronic health record processes to simplify order placement, coupled with patient navigation, may improve LCS in safety-net health care systems.

Background: Recent modifications to low-dose CT (LDCT)-based lung cancer screening guidelines increase the number of eligible individuals, particularly among racial and ethnic minorities. Because these populations disproportionately live in metropolitan areas, we analyzed the association between travel time and initial LDCT completion within an integrated, urban safety-net health care system. Methods: Using Esri's StreetMap Premium, OpenStreetMap, and the r5r package in R, we determined projected private vehicle and public transportation travel times between patient residence and the screening facility for LDCT ordered in March 2017 through December 2022 at Parkland Memorial Hospital in Dallas, Texas. We characterized associations between travel time and LDCT completion in univariable and multivariable analyses. We tested these associations in a simulation of 10,000 permutations of private vehicle and public transportation distribution. Results: A total of 2,287 patients were included in the analysis, of whom 1,553 (68%) completed the initial ordered LDCT. Mean age was 63 years, and 73% were underrepresented minorities. Median travel time from patient residence to the LDCT screening facility was 17 minutes by private vehicle and 67 minutes by public transportation. There was a small difference in travel time to the LDCT screening facility by public transportation for patients who completed LDCT versus those who did not (67 vs 66 min, respectively; P =.04) but no difference in travel time by private vehicle for these patients (17 min for both; P=.67). In multivariable analysis, LDCT completion was not associated with projected travel time to the LDCT facility by private vehicle (odds ratio, 1.01; 95% CI, 0.82-1.25) or public transportation (odds ratio, 1.14; 95% CI, 0.89-1.44). Similar results were noted across travel-type permutations. Black individuals were 29% less likely to complete LDCT screening compared with White individuals. Conclusions: In an urban population comprising predominantly underrepresented minorities, projected travel time is not associated with initial LDCT completion in an integrated health care system. Other reasons for differences in LDCT completion warrant investigation.

Abstract Background Patient navigation is an evidence-based intervention that reduces cancer health disparities by directly addressing the barriers to care for underserved patients with cancer. Variability in design and integration of patient navigation programs within cancer care settings has limited this intervention’s utility. The implementation science evaluation framework, RE-AIM, allows quantitative and qualitative examination of effective implementation of patient navigation programs into cancer care settings. Methods The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to evaluate implementation of a community-focused patient navigation intervention at an NCI-designated cancer center between June 2018 and October 2021. Using a 3-month longitudinal, non-comparative measurement period, univariate and bivariate analyses were conducted to examine associations between participant-level demographics and primary (i.e., barrier reduction) and secondary (i.e., patient-reported outcomes) effectiveness outcomes. Mixed methods analyses were used to examine adoption and delivery of the intervention into the cancer center setting. Process-level analyses were used to evaluate maintenance of the intervention. Results Participants (n = 311) represented a largely underserved population, as defined by the National Cancer Institute, with the majority identifying as Hispanic/Latino, having a household income of $35,000 or less, and being enrolled in Medicaid. Participants were diagnosed with a variety of cancer types and most had advanced staged cancers. Pre-post-intervention analyses indicated significant reduction from pre-intervention assessments in the average number of reported barriers, F(1, 207) = 117.62, p < .001, as well as significant increases in patient-reported physical health, t(205) = − 6.004, p < .001, mental health, t(205) = − 3.810, p < .001, self-efficacy, t(205) = − 5.321, p < .001, and satisfaction with medical team communication, t(206) = − 2.03, p = .029. Referral patterns and qualitative data supported increased adoption and integration of the intervention into the target setting, and consistent intervention delivery metrics suggested high fidelity to intervention delivery over time. Process-level data outlined a successful transition from a grant-funded community-focused patient navigation intervention to an institution-funded program. Conclusions This study utilized the implementation science evaluation framework, RE-AIM, to evaluate implementation of a community-focused patient navigation program. Our analyses indicate successful implementation within a cancer care setting and provide a potential guide for other oncology settings who may be interested in implementing community-focused patient navigation programs.

BACKGROUND:Innovations in lung cancer control and care have started to transform the landscape of lung cancer outcomes, but lung cancer stigma and biases have been implicated as a deterrent to realizing the promise of these innovations. Research has documented lung cancer stigma among the general public and lung cancer survivors (self-blame), as well as clinicians across many disciplines. However, studies have not explored lung cancer stigma in health-care trainees. These data seek to address that gap and inform efforts to prevent the emergence or mitigate the presence of lung cancer stigma among future clinicians. METHODS:Using clinical vignettes and a 2x2 factorial design, this investigation evaluated the impact of a history of smoking (yes vs no) and cancer diagnosis (lung vs colorectal) on perceptions of the described patient among 2 groups of preclinical health-care trainees (medical = 94 and nursing = 138). A charitable giving paradigm also asked participants to donate provided funds to 1 of 2 cancer advocacy organizations: one serving the lung cancer community and one serving the colorectal cancer community. RESULTS:In study 1, results revealed a consistent pattern of statistically significant and medium to large effect size differences regarding stigmatized perceptions (eg, higher stigmatizing behavior, increased pity, greater anger, and less helping) for individuals with a history of smoking but no reliable differences regarding cancer diagnosis. Analysis of data from nursing trainees in study 2 showed a similar pattern of statistically significant and medium to large effects pertaining to stigma behavior and perceptions of individuals who had a history of smoking depicted in the vignettes. The charitable giving paradigm did not identify any reliable difference between the groups in either study. CONCLUSIONS:Findings revealed a consistent pattern of health-care trainee perceptions that varied by smoking status but much less evidence that the cancer diagnosis contributed to different perceptions. This suggests that efforts to integrate consideration of stigma and biases in health-care training needs to adopt an approach that seeks to mitigate or eliminate stigmatizing perceptions and behaviors toward individuals with a history of smoking.

Multiple intervention strategies have been found effective for increasing physical activity among breast cancer survivors, yet most breast cancer survivors fail to meet physical activity recommendations. Optimization of interventions can facilitate real word implementation to ensure effective and efficient intervention delivery. Using a full-factorial design based on the Multiphase Optimization Strategy, 337 breast cancer survivors were randomized to receive a combination of four intervention components: (1) supervised exercise sessions, (2) facility membership, (3) Active Living Every Day (ALED), and (4) Fitbit. Moderate-to vigorous (MVPA) and light-intensity physical activity (LPA) were measured at baseline, 3 months, and 6 months with a hip-worn Actigraph GT3X+. Normal linear mixed models with separate intercepts for each subject were fit in the SAS 9.4 Mixed procedure. Participants who received supervised exercise sessions engaged in more MVPA, 153.58 min/week vs. 133.0 min/week (F = 3.97, p = 0.048) and LPA, 170.26 min/day versus 160.98 light PA minutes/day (F = 4.67, p = 0.032), compared to participants who did not receive supervised exercise. The effects of the three other intervention components on MVPA were not significant; however, those that received ALED engaged in less LPA (F = 6.6, p = 0.011). Supervised exercise sessions resulted in significant increases in MVPA and LPA in a sample of breast cancer survivors. Of note, these sessions were provided only during the first 6 weeks of the intervention and effects remained significant at 6 months. Results of this trial could inform future implementation efforts to ensure effective and efficient delivery of physical activity programs for breast cancer survivors.

Background Lung cancer screening has the potential to identify lung cancer at an early stage when more treatment options exist. However, discussions with and referrals of screening-eligible patients remain unacceptably low. We need to better understand clinician knowledge, attitudes, and practice patterns to identify strategies to improve lung cancer screening uptake. Prior studies have focused on understanding these factors from physicians only. Nevertheless, many patients receive primary care from nurse practitioners and physician assistants where prevention and early detection conversations are most likely to occur. Therefore, we must engage the full range of clinicians treating screening-eligible patients. Objectives The aim of this study was to describe attitudes, beliefs and referral practice patterns, lung cancer screening knowledge, and concordance with lung cancer screening guidelines among nurse practitioners, physicians, and physician assistants in the United States. Methods A descriptive, cross-sectional study was performed using survey methodology with clinical vignettes to examine clinician factors and concordance with U.S. Preventive Services Task Force lung cancer screening guidelines. Results Participants scored low on attitudes toward shared decision-making, high on the importance of shared decision-making in lung cancer screening, and low on barriers to lung cancer screening referral. In addition, midrange scores on empathy toward patients with smoking history were noted. Lung cancer screening knowledge was low regardless of clinician specialty; the most endorsed response when presented with a hypothetical patient was to refer for lung cancer screening using a chest X-ray. Discussion Findings demonstrate that most clinicians are nonconcordant with U.S. Preventive Services Task Force guidelines, erroneously believing a chest X-ray is appropriate for lung cancer screening. Clinicians must follow evidence-based practice guidelines, highlighting the need for targeted continuing education about lung cancer screening for clinicians who treat screening-eligible patients.