Leishman NJ, Wiener RS, Fagerlin A, et al. - Researchers conducted a retrospective cohort study of patients meeting current national eligibility criteria and considered appropriate candidates for lung cancer screening on the basis of clinical reminders completed over a 2-year period (2013–2015) at eight Department of Veterans Affairs medical facilities. Multilevel mixed-effects logistic regression models (conducted in 2019–2020) were applied to analyze predictors (age, gender, lung cancer risk, Charlson Comorbidity Index, travel distance to facility, and central vs outlying decision-making location) of primary outcomes of agreeing to and receiving lung cancer screening. This study included a total of 5,551 individuals (mean age=67 years, 97% male, mean lung cancer risk=0.7%, mean Charlson Comorbidity Index=1.14, median travel distance=24.2 miles), 3,720 (67%) of whom agreed to lung cancer screening and 2,398 (43%) received screening. There was a substantial variability in Veterans agreeing to and receiving lung cancer screening during the Veterans Affairs Lung Cancer Screening Demonstration Project. While the facility and clinician advising the patient had a large impact on lung cancer screening decisions, this variation was not explained by differences in key determinants of patient advantage.