Background <p>The limited integration of important aspects of lung cancer screening (LCS) into routine primary care practice has contributed to suboptimal LCS rates nationwide. We aimed to shed light on the pathways that facilitate LCS referral/order and completion in primary care patients, focusing on the screening workflows and processes.</p> Methods <p>We conducted semi-structured interviews with 10 providers and staff members at Jefferson Health, an urban U.S. health system that employs a hybrid approach to LCS. Data were analyzed using thematic analysis.</p> Results <p>We identified eight themes related to care coordination and systemic challenges in LCS processes in primary care. While medical assistants documented smoking status, physicians assessed eligibility and made referrals. Physicians generally abridged SDM discussions, deferring complete protocols to the LCS program. Referral practices varied, although most providers preferred referring patients to the dedicated LCS program due to time constraints, confidence in the program’s structure, and the streamlined follow-up process. Despite general guideline awareness, gaps remained in understanding specific criteria, such as age and smoking history. Providers emphasized the need to improve documentation of smoking history, integrate LCS quality metrics, and implement electronic health record interventions to support eligibility assessments, referrals, counseling, and timely follow-up.</p> Conclusions <p>Optimizing LCS delivery in primary care requires investment in electronic health record-based decision support, structured referral pathways, and provider education to close knowledge gaps and reduce workflow burdens. Hybrid approaches that integrate centralized program support with primary care engagement may enhance screening uptake and quality.</p> Clinical trial number <p>Not applicable.</p>