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Núñez ER, Ito Fukunaga M, Stevens GA, Yang JK, Reid SE, Spiegel JL, Ingemi MR, Wiener RS. Review of Interventions That Improve Uptake of Lung Cancer Screening: A Cataloging of Strategies That Have Been Shown to Work (or Not). Chest 2024; 166:632-648. [PMID: 38797278 DOI: 10.1016/j.chest.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/08/2024] [Accepted: 04/16/2024] [Indexed: 05/29/2024] Open
Abstract
TOPIC IMPORTANCE Lung cancer screening (LCS) has the potential to decrease mortality from lung cancer by 20%. Yet, more than a decade since LCS was established as an evidence-based practice, < 20% of the eligible population in the United States has been screened. This review focuses on critically appraising interventions that have been designed to increase the initial uptake of LCS, including how they address known barriers to LCS and their effectiveness in overcoming these barriers. REVIEW FINDINGS Studies were categorized based on the primary barriers that they addressed: (1) identifying eligible patients (including enhancing awareness through smoking history collection, outreach, and education), (2) shared decision-making-related interventions, and (3) patient navigation interventions. Four of the studies included multicomponent interventions, which often included patient navigation as one of the components. Overall, the effectiveness of the studies reviewed at improving LCS uptake generally was modest and was limited by the multilevel barriers that need to be overcome. Multicomponent interventions generally were more effective at improving LCS uptake, but most studies still had relatively low completion of screening. SUMMARY Improving uptake of LCS requires learning from prior interventions to design multilevel interventions that address barriers to LCS at key steps and identifying which components of these interventions are effective and generalizable.
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Affiliation(s)
- Eduardo R Núñez
- University of Massachusetts Chan Medical School-Baystate, Springfield, MA.
| | | | - Gregg A Stevens
- University of Massachusetts Chan Medical School Worcester, MA
| | - James K Yang
- University of Massachusetts Chan Medical School-Baystate, Springfield, MA
| | - Sarah E Reid
- University of Massachusetts Chan Medical School Worcester, MA
| | - Jennifer L Spiegel
- University of Massachusetts Chan Medical School Worcester, MA; School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Molly R Ingemi
- University of Massachusetts Chan Medical School-Baystate, Springfield, MA
| | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA; The Pulmonary Center, Boston University School of Medicine, Boston, MA; National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC
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Bade BC, Makhnevich A, Dauber-Decker KL, Solomon J, Cohn E, Chusid J, Raoof S, Silvestri G, Cohen SL. Qualitative interviews for hospitalists addressing lung cancer screening. Curr Probl Diagn Radiol 2024:S0363-0188(24)00157-9. [PMID: 39164184 DOI: 10.1067/j.cpradiol.2024.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 08/13/2024] [Indexed: 08/22/2024]
Abstract
Novel strategies are needed to improve low rates of lung cancer screening (LCS) in the US. Seeking to determine hospitalists' perspectives on leveraging hospitalizations to identify patients eligible for LCS, we performed qualitative interviews with eight hospitalists from two hospitals within a large integrated healthcare system. The interviews used semi-structured questions to assess (1) knowledge and practice of general screening and LCS guidelines from the United States Preventive Services Task Force (USPSTF), (2) identification of smoking history, and (3) hospitalists' views on how data obtained during hospitalization may be utilized to improve general screening and LCS post hospitalization. We ultimately reached the conclusion that hospitalists would support a dedicated program to identify hospitalized patients eligible for LCS and facilitate testing after discharge. Efforts to identify patients and arrange subsequent screening should be performed by team members outside the inpatient team.
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Affiliation(s)
- Brett C Bade
- Northwell, New Hyde Park, NY, USA; Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Alex Makhnevich
- Northwell, New Hyde Park, NY, USA; Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Katherine L Dauber-Decker
- Northwell, New Hyde Park, NY, USA; Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Jeffrey Solomon
- Northwell, New Hyde Park, NY, USA; Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Elizabeth Cohn
- Northwell, New Hyde Park, NY, USA; Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Jesse Chusid
- Northwell, New Hyde Park, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Suhail Raoof
- Northwell, New Hyde Park, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | | | - Stuart L Cohen
- Northwell, New Hyde Park, NY, USA; Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
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Adler DH, Wood N, Fiscella K, Rivera MP, Hernandez-Romero B, Chamberlin S, Abar B. Increasing Uptake of Lung Cancer Screening Among Emergency Department Patients: A Pilot Study. J Emerg Med 2024; 67:e164-e176. [PMID: 38839453 DOI: 10.1016/j.jemermed.2024.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/28/2024] [Accepted: 03/23/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer death in the United States. Lung cancer screening (LCS) decreases lung cancer mortality. Emergency department (ED) patients are at disproportionately high risk for lung cancer. The ED, therefore, is an optimal environment for interventions to promote LCS. OBJECTIVES Demonstrate the operational feasibility of identifying ED patients in need of LCS, referring them to LCS services, deploying a text message intervention to promote LCS, and conducting follow-up to determine LCS uptake. METHODS We conducted a randomized clinical trial to determine the feasibility and provide estimates of the preliminary efficacies of 1) basic referral for LCS and 2) basic referral plus a text messaging intervention, grounded in behavioral change theory, to promote uptake of LCS among ED patients. Participants aged 50 to 80, identified as eligible for LCS, were randomized to study arms and followed up at 150 days to assess interval LCS uptake (primary outcome), barriers to screening, and perceptions of the study interventions. RESULTS A total of 303 patients were surveyed, with 198 identified as eligible for LCS and subsequently randomized. Results indicated that 24% of participants with follow-up data received LCS (11% of the total randomized sample). Rates of screening at follow-up were similar across study arms. The intervention significantly improved normative perceptions of LCS (p = 0.015; Cohen's d = 0.45). CONCLUSION This pilot study demonstrates the feasibility of ED-based interventions to increase uptake of LCS among ED patients. A scalable ED-based intervention that increases LCS uptake could reduce lung cancer mortality.
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Affiliation(s)
- David H Adler
- Department of Emergency Medicine, University of Rochester, Rochester, New York.
| | - Nancy Wood
- Department of Emergency Medicine, University of Rochester, Rochester, New York
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester, Rochester, New York
| | - M Patricia Rivera
- Department of Medicine, University of Rochester, Rochester, New York
| | | | - Sydney Chamberlin
- Department of Emergency Medicine, University of Rochester, Rochester, New York
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester, Rochester, New York
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McInnerney D, Simmonds I, Hancock N, Rogerson S, Lindop J, Gabe R, Vulkan D, Marshall C, Crosbie PAJ, Callister MEJ, Quaife SL. Yorkshire Lung Screening Trial (YLST) pathway navigation study: a protocol for a nested randomised controlled trial to evaluate the effect of a pathway navigation intervention on lung cancer screening uptake. BMJ Open 2024; 14:e084577. [PMID: 38986555 PMCID: PMC11243133 DOI: 10.1136/bmjopen-2024-084577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/27/2024] [Indexed: 07/12/2024] Open
Abstract
INTRODUCTION Lung cancer is the most common cause of cancer death globally. In 2022 the UK National Screening Committee recommended the implementation of a national targeted lung cancer screening programme, aiming to improve early diagnosis and survival rates. Research studies and services internationally consistently observe socioeconomic and smoking-related inequalities in screening uptake. Pathway navigation (PN) is a process through which a trained pathway navigator guides people to overcome barriers to accessing healthcare services, including screening. This nested randomised controlled trial aims to determine whether a PN intervention results in more individuals participating in lung cancer screening compared with the usual written invitation within a previous non-responder population as part of the Yorkshire Lung Screening Trial (YLST). METHODS AND ANALYSIS A two-arm randomised controlled trial and process evaluation nested within the YLST. Participants aged 55-80 (inclusive) who have not responded to previous postal invitations to screening will be randomised by household to receive PN or usual care (a further postal invitation to contact the screening service for a lung health check) between March 2023 and October 2024. The PN intervention includes a postal appointment notification and prearranged telephone appointment, during which a pathway navigator telephones the participant, following a four-step protocol to introduce the offer and conduct an initial risk assessment. If eligible, participants are invited to book a low-dose CT (LDCT) lung cancer screening scan. All pathway navigators receive training from behavioural psychologists on motivational interviewing and communication techniques to elicit barriers to screening attendance and offer solutions. COPRIMARY OUTCOMES The number undergoing initial telephone assessment of lung cancer risk. The number undergoing an LDCT screening scan.Secondary outcomes include demographic, clinical and risk parameters of people undergoing telephone risk assessment; the number of people eligible for screening following telephone risk assessment; the number of screen-detected cancers diagnosed; costs and a mixed-methods process evaluation.Descriptive analyses will be used to present numbers, proportions and quantitative components of the process evaluation. Primary comparisons of differences between groups will be made using logistic regression. Applied thematic analysis will be used to interpret qualitative data within a conceptual framework based on the COM-B framework. A health economic analysis of the PN intervention will also be conducted. ETHICS AND DISSEMINATION The study is approved by the Greater Manchester West Research Ethics Committee (18-NW-0012) and the Health Research Authority following the Confidentiality Advisory Group review. Results will be shared through peer-reviewed scientific journals, conference presentations and on the YLST website. TRIAL REGISTRATION NUMBERS ISRCTN42704678 and NCT03750110.
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Affiliation(s)
- Daisy McInnerney
- Wolfson Institute of Population Health, Queen Mary University, London, UK
| | - Irene Simmonds
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Neil Hancock
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Suzanne Rogerson
- Department of Research and Innovation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jason Lindop
- Department of Research and Innovation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rhian Gabe
- Wolfson Institute of Population Health, Queen Mary University, London, UK
| | - Daniel Vulkan
- Wolfson Institute of Population Health, Queen Mary University, London, UK
| | | | - Philip A J Crosbie
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Wythenshawe, UK
| | - Matthew E J Callister
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Samantha L Quaife
- Wolfson Institute of Population Health, Queen Mary University, London, UK
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Japuntich SJ, Walaska K, Friedman EY, Balletto B, Cameron S, Tanzer JR, Fang P, Clark MA, Carey MP, Fava J, Busch AM, Breault C, Rosen R. Lung cancer screening provider recommendation and completion in black and White patients with a smoking history in two healthcare systems: a survey study. BMC PRIMARY CARE 2024; 25:202. [PMID: 38849725 PMCID: PMC11157907 DOI: 10.1186/s12875-024-02452-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 05/28/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Annual lung cancer screening (LCS) with low dose CT reduces lung cancer mortality. LCS is underutilized. Black people who smoke tobacco have high risk of lung cancer but are less likely to be screened than are White people. This study reports provider recommendation and patient completion of LCS and colorectal cancer screening (CRCS) among patients by race to assess for utilization of LCS. METHODS 3000 patients (oversampled for Black patients) across two healthcare systems (in Rhode Island and Minnesota) who had a chart documented age of 55 to 80 and a smoking history were invited to participate in a survey about cancer screening. Logistic regression analysis compared the rates of recommended and received cancer screenings. RESULTS 1177 participants responded (42% response rate; 45% White, 39% Black). 24% of respondents were eligible for LCS based on USPSTF2013 criteria. One-third of patients eligible for LCS reported that a doctor had recommended screening, compared to 90% of patients reporting a doctor recommended CRCS. Of those recommended screening, 88% reported completing LCS vs. 83% who reported completion of a sigmoidoscopy/colonoscopy. Black patients were equally likely to receive LCS recommendations but less likely to complete LCS when referred compared to White patients. There was no difference in completion of CRCS between Black and White patients. CONCLUSIONS Primary care providers rarely recommend lung cancer screening to patients with a smoking history. Systemic changes are needed to improve provider referral for LCS and to facilitate eligible Black people to complete LCS.
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Affiliation(s)
- Sandra J Japuntich
- Hennepin Healthcare, 730 South 8th St., Minneapolis, MN, 55415, USA.
- Hennepin Healthcare Research Institute, 701 Park Ave., PP7.700, Minneapolis, MN, 55415, USA.
- Department of Medicine, University of Minnesota Medical School, 401 East River Parkway, VCRC 1st Floor, Suite 131, Minneapolis, MN, 55455, USA.
| | - Kristen Walaska
- The Miriam Hospital, Coro Center West, 1 Hoppin St., Suite 309, Providence, RI, 02903, USA
| | - Elena Yuija Friedman
- Hennepin Healthcare Research Institute, 701 Park Ave., PP7.700, Minneapolis, MN, 55415, USA
| | - Brittany Balletto
- The Miriam Hospital, Coro Center West, 1 Hoppin St., Suite 309, Providence, RI, 02903, USA
| | - Sarah Cameron
- Hennepin Healthcare Research Institute, 701 Park Ave., PP7.700, Minneapolis, MN, 55415, USA
| | | | - Pearl Fang
- Hennepin Healthcare Research Institute, 701 Park Ave., PP7.700, Minneapolis, MN, 55415, USA
| | - Melissa A Clark
- Brown University School of Public Health, One Davol Square, 121 South Main St, Providence, RI, 02903, USA
| | - Michael P Carey
- Department of Psychiatry and Human Behavior, Brown University, 75 Waterman St, Providence, RI, 02912, USA
| | - Joseph Fava
- The Miriam Hospital, Coro Center West, 1 Hoppin St., Suite 309, Providence, RI, 02903, USA
| | - Andrew M Busch
- Hennepin Healthcare, 730 South 8th St., Minneapolis, MN, 55415, USA
- Hennepin Healthcare Research Institute, 701 Park Ave., PP7.700, Minneapolis, MN, 55415, USA
- Department of Medicine, University of Minnesota Medical School, 401 East River Parkway, VCRC 1st Floor, Suite 131, Minneapolis, MN, 55455, USA
| | - Christopher Breault
- The Miriam Hospital, Coro Center West, 1 Hoppin St., Suite 309, Providence, RI, 02903, USA
| | - Rochelle Rosen
- The Miriam Hospital, Coro Center West, 1 Hoppin St., Suite 309, Providence, RI, 02903, USA
- Brown University School of Public Health, One Davol Square, 121 South Main St, Providence, RI, 02903, USA
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Mossburg S, Kilany M, Jinnett K, Nguyen C, Soles E, Wood-Palmer D, Aly M. A Rapid Review of Interventions to Improve Care for People Who Are Medically Underserved with Multiple Sclerosis, Diabetic Retinopathy, and Lung Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:529. [PMID: 38791744 PMCID: PMC11121396 DOI: 10.3390/ijerph21050529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/11/2024] [Accepted: 04/19/2024] [Indexed: 05/26/2024]
Abstract
In the United States, patients with chronic conditions experience disparities in health outcomes across the care continuum. Among patients with multiple sclerosis, diabetic retinopathy, and lung cancer, there is a lack of evidence summarizing interventions to improve care and decrease these disparities. The aim of this rapid literature review was to identify interventions among patients with these chronic conditions to improve health and reduce disparities in screening, diagnosis, access to treatment and specialists, adherence, and retention in care. Using structured search terms in PubMed and Web of Science, we completed a rapid review of studies published in the prior five years conducted in the United States on our subject of focus. We screened the retrieved articles for inclusion and extracted data using a standard spreadsheet. The data were synthesized across clinical conditions and summarized. Screening was the most common point in the care continuum with documented interventions. Most studies we identified addressed interventions for patients with lung cancer, with half as many studies identified for patients with diabetic retinopathy, and few studies identified for patients with multiple sclerosis. Almost two-thirds of the studies focused on patients who identify as Black, Indigenous, or people of color. Interventions with evidence evaluating implementation in multiple conditions included telemedicine, mobile clinics, and insurance subsidies, or expansion. Despite documented disparities and a focus on health equity, a paucity of evidence exists on interventions that improve health outcomes among patients who are medically underserved with multiple sclerosis, diabetic retinopathy, and lung cancer.
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Affiliation(s)
- Sarah Mossburg
- American Institutes for Research, Arlington, VA 22202, USA
| | - Mona Kilany
- American Institutes for Research, Arlington, VA 22202, USA
| | - Kimberly Jinnett
- Department of Social and Behavioral Sciences, UCSF Institute for Health and Aging, San Francisco, CA 94158, USA
| | | | - Elena Soles
- American Institutes for Research, Arlington, VA 22202, USA
| | | | - Marwa Aly
- Department of Applied Health Sciences, School of Public Health, Indiana University Bloomington, Bloomington, IN 47405, USA
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Lin X, Lei F, Lin J, Li Y, Chen Q, Arbing R, Chen WT, Huang F. Promoting Lung Cancer Screen Decision-Making and Early Detection Behaviors: A Systematic Review and Meta-analysis. Cancer Nurs 2024:00002820-990000000-00227. [PMID: 38498799 DOI: 10.1097/ncc.0000000000001334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Promoting lung cancer screening (LCS) is complex. Previous studies have overlooked that LCS behaviors are stage based and thus did not identify the characteristics of LCS interventions at different screening stages. OBJECTIVE The aims of this study were to explore the characteristics and efficacy of interventions in promoting LCS decision making and behaviors and to evaluate these interventions. METHODS We conducted a study search from the inception of each bibliographic database to April 8, 2023. The precaution adoption process model was used to synthesize and classify the evidence. The RE-AIM framework was used to evaluate the effectiveness of LCS programs. Heterogeneity tests and meta-analysis were performed using RevMan 5.4 software. RESULTS We included 31 studies that covered 4 LCS topics: knowledge of lung cancer, knowledge of LCS, value clarification exercises, and LCS supportive resources. Patient decision aids outperformed educational materials in improving knowledge and decision outcomes with a significant reduction in decision conflict (standardized mean difference, 0.81; 95% confidence interval, -1.15 to -0.47; P < .001). Completion rates of LCS ranged from 3.6% to 98.8%. Interventions that included screening resources outperformed interventions that used patient decision aids alone in improving LCS completion. The proportions of reported RE-AIM indicators were highest for reach (69.59%), followed by adoption (43.87%), effectiveness (36.13%), implementation (33.33%), and maintenance (9.68%). CONCLUSION Evidence from 31 studies identified intervention characteristics and effectiveness of LCS interventions based on different stages of decision making. IMPLICATIONS FOR PRACTICE It is crucial to develop targeted and systematic interventions based on the characteristics of each stage of LCS to maximize intervention effectiveness and reduce the burden of lung cancer.
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Affiliation(s)
- Xiujing Lin
- Author Affiliations: School of Nursing, Fujian Medical University (Mss X Lin, J Lin, Li, and Q Chen, and Dr Huang), Fuzhou, China; School of Nursing, University of Minnesota (Dr Lei), Twin Cities, Minneapolis; and School of Nursing, University of California Los Angeles (Dr W-T Chen and Ms Arbing)
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Dodd RH, Sharman AR, Yap ML, Stone E, Marshall H, Rhee J, McCullough S, Rankin NM. "We need to work towards it, whatever it takes."-participation factors in the acceptability and feasibility of lung cancer screening in Australia: the perspectives of key stakeholders. Transl Lung Cancer Res 2024; 13:240-255. [PMID: 38496699 PMCID: PMC10938089 DOI: 10.21037/tlcr-23-623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/10/2024] [Indexed: 03/19/2024]
Abstract
Background Low dose computed tomography (LDCT) screening, targeted at those at high-risk, has been shown to significantly reduce lung cancer mortality and detect cancers at an early stage. Practical, attitudinal and demographic factors can inhibit screening participation in high-risk populations. This study aimed to explore stakeholders' views about barriers and enablers (determinants) to participation in lung cancer screening (LCS) in Australia. Methods Twenty-four focus groups (range 2-5 participants) were conducted in 2021 using the Zoom platform. Participants were 84 health professionals, researchers, policy makers and program managers of current screening programs. Focus groups consisted of a structured presentation with facilitated discussion lasting about 1 hour. The content was analysed thematically and mapped to the Consolidated Framework for Implementation Research (CFIR). Results Screening determinants were identified across each stage of the proposed screening and assessment pathway. Challenges included participant factors such as encouraging participation for individuals at high-risk, whilst ensuring that access and equity issues were carefully considered in program design. The development of awareness campaigns that engaged LCS participants and health professionals, as well as streamlined referral processes for initial entry and follow-up, were strongly advocated for. Considering practical factors included the use of mobile vans in convenient locations. Conclusions Participants reported that LCS in Australia was acceptable and feasible. Participants identified a complex set of determinants across the proposed screening and assessment pathway. Strategies that enable the best chance for program success must be identified prior to implementation of a national LCS program.
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Affiliation(s)
- Rachael Helen Dodd
- The Daffodil Centre, A Joint Venture between The University of Sydney and Cancer Council New South Wales, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, New South Wales, Australia
| | - Ashleigh Rebecca Sharman
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, New South Wales, Australia
| | - Mei Ling Yap
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, New South Wales, Australia
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute, University of New South Wales Sydney, Liverpool, New South Wales, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Western Sydney University, Campbelltown, New South Wales, Australia
- The George Institute, University of New South Wales Sydney, New South Wales, Australia
| | - Emily Stone
- Department of Thoracic Medicine and Lung Transplantation, St Vincent’s Hospital Sydney, New South Wales, Australia
- School of Clinical Medicine University of New South Wales Sydney, New South Wales, Australia
| | - Henry Marshall
- University of Queensland Thoracic Research Centre and Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Joel Rhee
- School of Population Health, Faculty of Medicine and Health, University of New South Wales Sydney, New South Wales, Australia
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sue McCullough
- Thoracic Oncology Group Australasia Consumer Advisory Panel, Melbourne, Victoria, Australia
| | - Nicole Marion Rankin
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
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Scruton S, Warner G, Kendell C, Pfaff K, Stajduhar K, Patrick L, Dujela C, Fauteux F, Urquhart R. Navigation programs to support community-dwelling individuals with life-limiting illness: determinants of implementation. BMC Health Serv Res 2024; 24:39. [PMID: 38184522 PMCID: PMC10770879 DOI: 10.1186/s12913-024-10541-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/01/2024] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND As the Canadian population ages and the prevalence of chronic illnesses increases, delivering high-quality care to individuals with advanced life limiting illnesses becomes more challenging. Community-based navigation programs are a promising approach to address these challenges, but little is known about how these programs are successfully implemented to meet the needs of this population. This study sought to identify the key determinants that contribute to the successful implementation of these programs within Canada. METHODS A qualitative study was undertaken to understand the implementation of eleven innovative, community-based navigation programs that aim to address the needs of individuals with life-limiting illnesses as they approach the end of life. The Consolidated Framework for Implementation Research (CFIR) guided the study design. Key informants (n = 23) within these programs took part in semi-structured interviews where they were asked to discuss how these programs are implemented. Data were analyzed using techniques employed in qualitative description. RESULTS We identified key determinants of successful implementation within each CFIR domain. In the outer setting domain, participants emphasized the importance of filling gaps in care to meet client needs, developing strong relationships with clients and community-based organizations, and navigating relationships with healthcare providers. At the inner setting level, leadership support, staff compatibility, and available resources were identified as important factors. In terms of intervention characteristics, the ability to adapt was cited as a facilitator, whereas costs were identified as a barrier. For the characteristics of individuals, participants described the importance of having staff whose values align with the program, and who have the experience and skills necessary to work with complex clients. Finally, having strong champions and evaluation processes were highlighted as important process-oriented determinants of successful implementation. CONCLUSION This study provides valuable insights into the determinants of successful implementation of community-based navigation programs in Canada. Understanding these determinants can guide the future development and integration of navigation programs to successfully meet the needs of those with life-limiting illnesses.
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Affiliation(s)
- Sarah Scruton
- Department of Community Health and Epidemiology, Centre for Clinical Research, Dalhousie University, Room 413, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada
| | - Cynthia Kendell
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Kathryn Pfaff
- Faculty of Nursing, University of Windsor, Windsor, ON, Canada
| | - Kelli Stajduhar
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | - Linda Patrick
- Faculty of Nursing, University of Windsor, Windsor, ON, Canada
| | - Carren Dujela
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | - Faith Fauteux
- Faculty of Nursing, University of Windsor, Windsor, ON, Canada
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Centre for Clinical Research, Dalhousie University, Room 413, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada.
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Sorscher S. Inadequate Uptake of USPSTF-Recommended Low Dose CT Lung Cancer Screening. J Prim Care Community Health 2024; 15:21501319241235011. [PMID: 38400557 PMCID: PMC10894545 DOI: 10.1177/21501319241235011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
In 2023, Journal of Primary Care and Community Health published the results of 4 outstanding studies in which investigators aimed to explore and improve clinician and eligible individuals' knowledge of the rationale for lung cancer screening (LCS). Their results highlighted the underutilization of LCS, particularly for certain high risk populations, and the continued disparities in screening seen between groups of eligible individuals. Here, key findings from those 2023 Journal of Primary Care and Community Health reports, along with salient findings of other recent LCS reports, are discussed. The bases for the United States Preventive Task Force (USPSTF) LCS recommendations, barriers primary care providers face, the perspective of eligible individuals, importance of shared decision-making (SDM) and disparities between groups in LCS are reviewed along with potential strategies to ensure that more eligible individuals are offered LCS.
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Matthews AK, Inwanna S, Oyaluade D, Chappel A, Akufo J, Kim SJ, Jeremiah R. Exploration of experiences and attitudes associated with lung health promotion among Black males with a history of smoking. JOURNAL OF MEN'S HEALTH 2024; 20:20-34. [PMID: 39184220 PMCID: PMC11340808 DOI: 10.22514/jomh.2024.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024] Open
Abstract
To examine knowledge and attitudes about lung health promotion (smoking cessation and lung cancer screening) among Black male smokers in a large Midwestern city in the United States. Semi-structured, in-depth interviews were conducted with 25 study participants. Each interview lasted approximately 45 minutes. Participants also completed a brief (5-10 minutes) survey measuring demographic characteristics, smoking experiences and knowledge and attitudes about lung health promotion activities. Descriptive statistics were used for quantitative data, and deductive thematic analysis for qualitative data analysis. The mean age of study participants was 57.5 years. Eighty-four percent of participants were current smokers, with the majority being daily smokers. Perceived risk for lung cancer was mixed, with 56% of participants endorsing that they considered themselves to be at high or moderate risk and the remaining 44% at low or no risk for lung cancer. Forty percent of participants reported having had a test to check their lungs for cancer. Participants were aware of the health risks associated with smoking but reported limited assistance from providers regarding the receipt of smoking cessation treatments. Awareness of lung cancer screening was limited, but participants expressed openness to screening; however, barriers were anticipated, including costs, fear and a reduced willingness to be screened in the absence of symptoms. Study participants reported limited experiences with lung health promotion activities. Knowledge about the facilitators and barriers can be used to develop health promotion interventions targeting smoking cessation and lung cancer screening.
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Affiliation(s)
| | - Suchanart Inwanna
- College of Nursing, the University of Illinois Chicago, Chicago, IL 60612, USA
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 10400 Bangkok, Thailand
| | - Dami Oyaluade
- Cancer Center, the University of Illinois Hospital, Chicago, IL 60612, USA
| | - Alexis Chappel
- Northeastern Illinois University, Chicago, IL 60625, USA
| | - Jennifer Akufo
- College of Nursing, the University of Illinois Chicago, Chicago, IL 60612, USA
| | - Sage J. Kim
- School of Public Health, the University of Illinois Chicago, Chicago, IL 60612, USA
| | - Rohan Jeremiah
- College of Nursing, the University of Illinois Chicago, Chicago, IL 60612, USA
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Copeland J, Neal E, Phillips W, Hofferberth S, Lathan C, Donington J, Colson Y. Restructuring lung cancer care to accelerate diagnosis and treatment in patients vulnerable to healthcare disparities using an innovative care model. MethodsX 2023; 11:102338. [PMID: 37701734 PMCID: PMC10494257 DOI: 10.1016/j.mex.2023.102338] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/19/2023] [Indexed: 09/14/2023] Open
Abstract
The diagnosis and treatment of lung cancer is challenged by complex diagnostic pathways and fragmented care that can lead to disparities for vulnerable patients. Our model involved a multi-institutional, multidisciplinary conference to address the complexity of lung cancer care in vulnerable patient populations. The conference was conducted using a process adapted from the problem-solving method entitled FastTrack, pioneered by General Electric. Conference attendees established critical social determinants of health specific to lung cancer and designed a practical care model to accelerate diagnosis and treatment in this population. The resulting care delivery model, the Lung Cancer Strategist Program (LCSP), was led by a lung cancer trained advanced practice provider (APP) to expedite diagnosis, surgical and oncologic consultation, and treatment of a suspicious lung nodule. We compared the timeliness of care, care efficiency, and oncologic outcomes in 100 LCSP patients and 100 routine referral patients at the same thoracic surgery clinic. Patient triage through our integrated care model transitioned initial referral evaluation to a lung cancer trained APP to coordinate multidisciplinary patient-centered care that was highly individualized and significantly reduced the time to diagnosis and treatment among vulnerable patients at high-risk for treatment delay due to healthcare disparities.•To develop the Lung Cancer Strategist Program care model, we used a three-step (Design, Meeting, and Culmination), team-based, problem-solving process entitled FastTrack.•An advantage of FastTrack is its ability to overcome barriers embedded within hierarchal and institutional social systems, empowering those closest to the relevant issue to propose and enact meaningful change.•Under this framework, we engaged a diverse field of experts to assess systemic barriers in lung cancer care and design an innovative care pathway to improve the timeliness and efficiency of lung cancer care in patients at risk for healthcare disparities.
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Affiliation(s)
- Jessica Copeland
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Eliza Neal
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Will Phillips
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sophie Hofferberth
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Christopher Lathan
- Division of Medical Oncology, Department of Medicine, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Jessica Donington
- Division of Thoracic Surgery, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Yolonda Colson
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Urquhart R, Kendell C, Pfaff K, Stajduhar K, Patrick L, Dujela C, Scruton S, Fauteux F, Warner G. How do navigation programs address the needs of those living in the community with advanced, life-limiting Illness? A realist evaluation of programs in Canada. BMC Palliat Care 2023; 22:179. [PMID: 37964238 PMCID: PMC10647106 DOI: 10.1186/s12904-023-01304-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND We sought to identify innovative navigation programs across Canadian jurisdictions that target their services to individuals affected by life-limiting illness and their families, and articulate the principal components of these programs that enable them to address the needs of their clients who are living in the community. METHODS This realist evaluation used a two-phased approach. First, we conducted a horizon scan of innovative community-based navigation programs across Canadian jurisdictions to identify innovative community-based navigation programs that aim to address the needs of community-dwelling individuals affected by life-limiting illness. Second, we conducted semi-structured interviews with key informants from each of the selected programs. Informants included individuals responsible for managing and delivering the program and decision-makers with responsibility and/or oversight of the program. Analyses proceeded in an iterative manner, consistent with realist evaluation methods. This included iteratively developing and refining Context-Mechanism-Outcome (CMO) configurations, and developing the final program theory. RESULTS Twenty-seven navigation programs were identified from the horizon scan. Using specific eligibility criteria, 11 programs were selected for subsequent interviews and in-depth examination. Twenty-three participants were interviewed from these programs, which operated in five Canadian provinces. The programs represented a mixture of community (non-profit or volunteer), research-initiated, and health system programs. The final program theory was articulated as: navigation programs can improve client outcomes if they have supported and empowered staff who have the time and flexibility to personalize care to the needs of their clients. CONCLUSIONS The findings highlight key principles (contexts and mechanisms) that enable navigation programs to develop client relationships, personalize care to client needs, and improve client outcomes. These principles include staff (or volunteer) knowledge and experience to coordinate health and social services, having a point of contact after hours, and providing staff (and volunteers) time and flexibility to develop relationships and respond to individualized client needs. These findings may be used by healthcare organizations - outside of navigation programs - to work towards more person-centred care.
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Affiliation(s)
- Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Room 413, Halifax, NS, Canada.
| | - Cynthia Kendell
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Kathryn Pfaff
- Faculty of Nursing, University of Windsor, Windsor, ON, Canada
| | - Kelli Stajduhar
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | - Linda Patrick
- Faculty of Nursing, University of Windsor, Windsor, ON, Canada
| | - Carren Dujela
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | - Sarah Scruton
- Department of Community Health and Epidemiology, Dalhousie University, Room 413, Halifax, NS, Canada
| | - Faith Fauteux
- Faculty of Nursing, University of Windsor, Windsor, ON, Canada
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada
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Reilly M, Ali A, Doyle PF, Cotter S, Heavey L, Brain PK, Rankin PN, Mccutchan G, Redmond PP. Co-designing a recruitment strategy for lung cancer screening in high-risk individuals: protocol for a mixed-methods study. HRB Open Res 2023; 6:64. [PMID: 38911612 PMCID: PMC11190654 DOI: 10.12688/hrbopenres.13793.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 06/25/2024] Open
Abstract
Background Lung cancer is a significant cause of cancer-related mortality globally, with early detection through screening critical to improving patient outcomes. However, recruiting high-risk individuals, particularly in deprived populations, for screening remains a considerable challenge. This study aims to co-design a targeted recruitment strategy for lung cancer screening, tailored to the specific needs and experiences of high-risk individuals, in collaboration with a Patient and Public Involvement (PPI) panel and expert stakeholders in Ireland. Methods We will employ a mixed-methods design guided by the Medical Research Council (MRC) framework for developing complex interventions. Our approach will integrate systematic review findings on screening participation interventions, evaluation of the recruitment strategy's feasibility in an Irish context, and the application of behavioural science frameworks. The target population includes individuals over 55 years, either current smokers or those who quit within the last year, who reside in highly deprived areas. Conclusion This co-designed recruitment strategy will combine evidence-based research, local context understanding, and stakeholder input to develop a solution that is both scientifically robust and tailored to the target population's needs. This patient-centred approach aims to increase the potential for successful implementation of lung cancer screening programs, thereby improving early detection and patient outcomes.
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Affiliation(s)
- Maeve Reilly
- Department of General Practice, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Ahmeda Ali
- Department of General Practice, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Prof Frank Doyle
- Department of Health Psychology, School of Population Health, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Seamus Cotter
- Patient and Public Involvement (PPI), Irish Lung Cancer Community, Dublin, Ireland
| | - Laura Heavey
- National Screening Service, Health Service Executive (HSE), Dublin, Ireland
| | - Prof Kate Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Prof Nicole Rankin
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Grace Mccutchan
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Prof Patrick Redmond
- Department of General Practice, Royal College of Surgeons Ireland, Dublin, Ireland
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15
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Leopold KT, Carter-Bawa L. Barriers to Lung Cancer Screening Access from the Perspective of the Patient and Current Interventions. Thorac Surg Clin 2023; 33:343-351. [PMID: 37806737 DOI: 10.1016/j.thorsurg.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
In the context of the Conceptual Model for Lung Cancer Screening Participation, this article describes patient barriers to lung cancer screening highlighting current interventions. Patient barriers include cognitive factors (lack of awareness, limited information/misinformation, and low perceived risk), factors related to access (logistical issues, no provider recommendation, cost, and other financial/social factors), and psychological factors (fear, fatalism, lung cancer worry, and stigma). Current interventions include the use of educational materials/presentations to address cognitive barriers, use of direct outreach and structural change to address factors related to access, and use of educational material focused on psychological barriers to address psychological barriers.
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Affiliation(s)
- Katherine T Leopold
- Hackensack University School of Medicine, 123 Metro Boulevard, Nutley, NJ 07110, USA
| | - Lisa Carter-Bawa
- Cancer Prevention Precision Control Institute, Center for Discovery & Innovation, at Hackensack Meridian Health, 111 Ideation Way, B430, Nutley, NJ 07110, USA.
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Whitham T, Wima K, Harnett B, Kues JR, Eckman MH, Starnes SL, Schmidt KA, Kapur S, Salfity H, Van Haren RM. Lung cancer screening utilization rate varies based on patient, provider, and hospital factors. J Thorac Cardiovasc Surg 2023; 166:1331-1339. [PMID: 36934071 DOI: 10.1016/j.jtcvs.2023.01.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/26/2022] [Accepted: 01/20/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVE Low-dose computed tomography has been proven to reduce mortality, yet utilization remains low. The purpose of this study is to identify factors that impact the utilization of lung cancer screening. METHODS We performed a retrospective review of our institution's primary care network from November 2012 to June 2022 to identify patients who were eligible for lung cancer screening. Eligible patients were 55 to 80 years of age and current or former smokers with at least a 30 pack-year history. Analyses were performed on the screened populations and patients who met eligibility criteria but were not screened. RESULTS A total of 35,279 patients in our primary care network were current/former smokers aged 55 to 80 years. A total of 6731 patients (19%) had a 30 pack-year or more cigarette history, and 11,602 patients (33%) had an unknown pack-year history. A total of 1218 patients received low-dose computed tomography. The utilization rate of low-dose computed tomography was 18%. The utilization rate was significantly lower (9%) if patients with unknown pack-year history were included (P < .001). The utilization rates between primary care clinic locations were significantly different (range, 18% vs 41%, P < .05). Utilization of low-dose computed tomography on multivariate analysis was associated with Black race, former smoker, chronic obstructive pulmonary disease, bronchitis, family history of lung cancer, and number of primary care visits (all P < .05). CONCLUSIONS Lung cancer screening utilization rates are low and vary significantly on the basis of patient comorbidities, family history of lung cancer, primary care clinic location, and accurate documentation of pack-year cigarette history. The development of programs to address patient, provider, and hospital-level factors is needed to ensure appropriate lung cancer screening.
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Affiliation(s)
- Tarik Whitham
- College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio
| | - Koffi Wima
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Brett Harnett
- Department of Biomedical Informatics, University of Cincinnati, Cincinnati, Ohio
| | - John R Kues
- Center for Improvement Science, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Mark H Eckman
- Division of General Internal Medicine, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Sandra L Starnes
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Katherine A Schmidt
- Division of General Internal Medicine, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Sangita Kapur
- Division of Cardiopulmonary Imaging, Department of Radiology, University of Cincinnati, Ohio
| | - Hai Salfity
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Robert M Van Haren
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
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Triplette M, Brown MC, Snidarich M, Budak JZ, Giustini N, Murphy N, Romine PE, Weiner BJ, Crothers K. Lung Cancer Screening in People With HIV: A Mixed-Methods Study of Patient and Provider Perspectives. Am J Prev Med 2023; 65:608-617. [PMID: 37146840 PMCID: PMC10524954 DOI: 10.1016/j.amepre.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 05/07/2023]
Abstract
INTRODUCTION People with HIV are at higher risk of lung cancer; however, there is limited research on attitudes, barriers, and facilitators to lung cancer screening in people with HIV. The objective of this study was to understand the perspectives on lung cancer screening among people with HIV and their providers. METHODS Surveys of people with HIV and HIV-care providers were complemented by qualitative focus groups and interviews designed to understand the determinants of lung cancer screening in people with HIV. Participants were recruited through an academic HIV clinic in Seattle, WA. Qualitative guides were developed by integrating the Consolidated Framework for Implementation Research and the Tailored Implementation of Chronic Diseases checklist. Themes that emerged from thematic analyses of qualitative data were compared with surveys in joint displays. All study components were conducted between 2021 and 2022. RESULTS Sixty-four people with HIV completed surveys, and 43 participated in focus groups. Eleven providers completed surveys, and 10 were interviewed for the study. Themes from joint displays show overall enthusiasm for lung cancer screening among people with HIV and their providers, particularly with a tailored and evidence-based approach. Facilitators in this population may include longstanding engagement with providers and health systems and an emphasis on survivorship through preventive healthcare interventions. People with HIV may also face barriers acknowledged by providers, including a high level of medical comorbidities and competing issues such as substance abuse, mental health concerns, and economic instability. CONCLUSIONS This study reveals that people with HIV and their providers have overall enthusiasm toward screening. However, tailored interventions may be needed to overcome specific barriers, including complex decision making in the setting of medical comorbidity and patient competing issues.
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Affiliation(s)
- Matthew Triplette
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington.
| | - Meagan C Brown
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington; Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Madison Snidarich
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Jehan Z Budak
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
| | - Nicholas Giustini
- Division of Hematology, Department of Medicine, University of Washington, Seattle, Washington
| | - Nicholas Murphy
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington
| | | | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, Washington; Department of Health Systems and Population Health, University of Washington, Seattle, Washington
| | - Kristina Crothers
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington; Veterans Affairs Puget Sound Health Care System, Seattle, Washington
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Mizrahi J, Marhaba J, Buniak W, Sun E. Transition-of-care program from emergency department to gastroenterology clinics improves follow-up. Am J Emerg Med 2023; 69:154-159. [PMID: 37121064 DOI: 10.1016/j.ajem.2023.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/16/2023] [Accepted: 04/20/2023] [Indexed: 05/02/2023] Open
Abstract
OBJECTIVES Patients discharged from the emergency department (ED) with gastrointestinal (GI) symptoms need to appropriately transition their care to a GI outpatient clinic in a timely manner to have their health needs met and avoid significant morbidity. When this transition isn't optimal, patients are lost to follow-up, potentially placing them at risk for adverse events. We sought to study the effectiveness of implementing an electronic medical record (EMR) based transition-of-care (TOC) program from the ED to outpatient GI clinics. METHODS We performed a retrospective single center cohort study of patients discharged from the ED of a tertiary care academic medical center referred to outpatient GI clinic before (Pre-TOC patients) and after implementation of an EMR based TOC program (TOC patients). We further stratified patients based on the Distressed Communities Index (DCI), which is a composite measure of economic well-being. We compared rates of appointment scheduling and appointment attendance between the two groups, as well as 30-day readmission rates to the ED. We also performed a subgroup analysis to determine if socioeconomic status would affect patient follow-up rates. RESULTS We included 380 Pre-TOC and 399 TOC patients in our analysis. TOC patients were found to both schedule appointments (50% vs 27% p-value <0.01) as well as show up to appointments (34% vs 24% p-value <0.01) at significantly higher rates compared to Pre-TOC patients. There was no significant difference between 30-day readmission rates between the two groups. In addition, TOC patients from At-Risk and Distressed Communities were over 22 times more likely to schedule an appointment compared to Pre-TOC patients from similar neighborhoods (OR 22.18, 95% CI 4.23-116.32). CONCLUSION Our study shows that patients who are discharged from the ED with outpatient GI follow-up are more likely to both schedule and show up to appointments with implementation of an EMR-based direct referral program compared to no patient navigation, particularly among patients of lower socioeconomic status.
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Affiliation(s)
- Joseph Mizrahi
- Department of Medicine, Division of Gastroenterology and Hepatology, Stony Brook University Hospital, 101 Nicolls Road, Health Science Tower, Level 17, Room 060, Stony Brook, NY 11794-8173, United States of America.
| | - Jade Marhaba
- Department of Medicine, Division of Gastroenterology and Hepatology, Stony Brook University Hospital, 101 Nicolls Road, Health Science Tower, Level 17, Room 060, Stony Brook, NY 11794-8173, United States of America.
| | - William Buniak
- Division of Gastroenterology, Wright Center for Graduate Medical Education, 501 South Washington Avenue, Scranton, PA 18510, United States of America
| | - Edward Sun
- Division of Gastroenterology and Hepatology, Peconic Bay Medical Center, 1300 Roanoke Ave, Riverhead, NY 11901, United States of America.
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Bastani M, Chiuzan C, Silvestri G, Raoof S, Chusid J, Diefenbach M, Cohen SL. A predictive model for lung cancer screening nonadherence in a community setting health-care network. JNCI Cancer Spectr 2023; 7:pkad019. [PMID: 37027213 PMCID: PMC10097452 DOI: 10.1093/jncics/pkad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Lung cancer screening (LCS) decreases lung cancer mortality. However, its benefit may be limited by nonadherence to screening. Although factors associated with LCS nonadherence have been identified, to the best of our knowledge, no predictive models have been developed to predict LCS nonadherence. The purpose of this study was to develop a predictive model leveraging a machine learning model to predict LCS nonadherence risk. METHODS A retrospective cohort of patients who enrolled in our LCS program between 2015 and 2018 was used to develop a model to predict the risk of nonadherence to annual LCS after the baseline examination. Clinical and demographic data were used to fit logistic regression, random forest, and gradient-boosting models that were internally validated on the basis of accuracy and area under the receiver operating curve. RESULTS A total of 1875 individuals with baseline LCS were included in the analysis, with 1264 (67.4%) as nonadherent. Nonadherence was defined on the basis of baseline chest computed tomography (CT) findings. Clinical and demographic predictors were used on the basis of availability and statistical significance. The gradient-boosting model had the highest area under the receiver operating curve (0.89, 95% confidence interval = 0.87 to 0.90), with a mean accuracy of 0.82. Referral specialty, insurance type, and baseline Lung CT Screening Reporting & Data System (LungRADS) score were the best predictors of nonadherence to LCS. CONCLUSIONS We developed a machine learning model using readily available clinical and demographic data to predict LCS nonadherence with high accuracy and discrimination. After further prospective validation, this model can be used to identify patients for interventions to improve LCS adherence and decrease lung cancer burden.
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Affiliation(s)
- Mehrad Bastani
- Department of Radiology, Northwell Health, Manhasset, NY, USA
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Codruta Chiuzan
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Gerard Silvestri
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Suhail Raoof
- Department of Pulmonary Medicine, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, USA
| | - Jesse Chusid
- Department of Radiology, Northwell Health, Manhasset, NY, USA
- Department of Pulmonary Medicine, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, USA
| | | | - Stuart L Cohen
- Department of Radiology, Northwell Health, Manhasset, NY, USA
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Department of Pulmonary Medicine, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, USA
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Sayani A, Ali MA, Dey P, Corrado AM, Ziegler C, Nicholson E, Lofters A. Interventions Designed to Increase the Uptake of Lung Cancer Screening: An Equity-Oriented Scoping Review. JTO Clin Res Rep 2023; 4:100469. [PMID: 36938372 PMCID: PMC10015251 DOI: 10.1016/j.jtocrr.2023.100469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/17/2023] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Participation in lung cancer screening (LCS) is lower in populations with the highest burden of lung cancer risk (through the social patterning of smoking behavior) and lowest levels of health care utilization (through structurally inaccessible care) leading to a widening of health inequities. Methods We conducted a scoping review using the Arksey and O'Malley methodological framework to inform equitable access to LCS by illuminating knowledge and implementation gaps in interventions designed to increase the uptake of LCS. We comprehensively searched for LCS interventions (Ovid Medline, Excerpta Medica database, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and Scopus from 2000 to June 22, 2021) and included peer-reviewed articles and gray literature published in the English language that describe an intervention designed to increase the uptake of LCS, charted data using our previously published tool and conduced a health equity analysis to determine the intended-unintended and positive-negative outcomes of the interventions for populations experiencing the greatest inequities. Results Our search yielded 3572 peer-reviewed articles and 54,292 pieces of gray literature. Ultimately, we included 35 peer-reviewed articles and one gray literature. The interventions occurred in the United States, United Kingdom, Japan, and Italy, focusing on shared decision-making, the use of electronic health records as reminders, patient navigation, community-based campaigns, and mobile computed tomography scanners. We developed an equity-oriented LCS framework and mapped the dimensions and outcomes of the interventions on access to LCS on the basis of approachability, acceptability, availability, affordability, and appropriateness of the intervention. No intervention was mapped across all five dimensions. Most notably, knowledge and implementation gaps were identified in dimensions of acceptability, availability, and affordability. Conclusions Interventions that were most effective in improving access to LCS targeted priority populations, raised community-level awareness, tailored materials for sociocultural acceptability, did not depend on prior patient engagement/registration with the health care system, proactively considered costs related to participation, and enhanced utilization through informed decision-making.
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Affiliation(s)
- Ambreen Sayani
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Corresponding author. Address for correspondence: Ambreen Sayani, MD, PhD, Women’s College Research Institute, Women’s College Hospital, 76 Grenville St., Toronto, ON M5S 1B2, Canada.
| | - Muhanad Ahmed Ali
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Pooja Dey
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Ann Marie Corrado
- Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, Ontario, Canada
| | - Carolyn Ziegler
- Library Services, Unity Health Toronto, Toronto, Ontario, Canada
| | | | - Aisha Lofters
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family Medicine, Women’s College Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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Practical Approaches to Advancing Health Equity in Radiology, From the AJR Special Series on DEI. AJR Am J Roentgenol 2023:1-10. [PMID: 36629307 DOI: 10.2214/ajr.22.28783] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Despite significant advances in healthcare, many patients from medically underserved populations are impacted by existing healthcare disparities. Radiologists are uniquely positioned to decrease health disparities and advance health equity efforts in their practices. However, literature on practical tools for advancing radiology health equity efforts applicable to a wide variety of patient populations and care settings is lacking. Therefore, this article seeks to equip radiologists with an evidence-based and practical knowledge toolkit of health equity strategies, presented in terms of four pillars of research, clinical care, education, and innovation. For each pillar, equity efforts across diverse patient populations and radiology practice settings are examined through the lens of existing barriers, current best practices, and future directions, incorporating practical examples relevant to a spectrum of patient populations. Health equity efforts provide an opportune window to transform radiology through personalized care delivery that is responsive to diverse patient needs. Guided by compassion and empathy as core principles of health equity, leveraging the four pillars provides a helpful framework to advance health equity efforts as a step towards social justice in health.
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Kokorelias KM, Markoulakis R, Hitzig SL. Considering a Need for Dementia-Specific, Family-Centered Patient Navigation in Canada. J Appl Gerontol 2023; 42:19-27. [PMID: 36503280 DOI: 10.1177/07334648221125781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Patient navigation has been proposed as a novel family-centered, integrated care model to address the care needs of persons living with dementia and their family caregivers by helping them navigate the complex range of dementia services offered in hospital and community settings. A key informant qualitative descriptive study explored the perspectives of 48 healthcare professionals to explore the need for dementia-specific patient navigation. Data were analyzed thematically. We identified one overarching theme: "Variability in the Need for Illness-Specific Patient Navigation" and five themes that highlight considerations when providing navigation to individuals with dementia: (1) Taking Part in Ongoing Training, (2) Addressing Stigma, (3) Focusing on Quality of Life, (4) Defining Home, and (5) A Continuous Process of Support. These themes provide preliminary insights into the conceptual differences about the need for illness-specific patient navigation and the areas within patient navigation where healthcare professionals are encouraged to find consensus.
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Affiliation(s)
- Kristina M Kokorelias
- St John's Rehab Research Program, Sunnybrook Health Sciences Centre, 574553Sunnybrook Research Institute, Toronto, ON, Canada
| | - Roula Markoulakis
- Family Navigation Project, 574553Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sander L Hitzig
- St John's Rehab Research Program, Sunnybrook Health Sciences Centre, 574553Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Temerty Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada to, Rehabilitation Sciences Institute, Temerty Faculty of Medicine University of Toronto, Toronto, ON, Canada
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23
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Hospitalization as an opportunity to engage underserved individuals in shared decision-making for lung cancer screening: results from two randomized pilot trials. Cancer Causes Control 2022; 33:1373-1380. [PMID: 35997854 DOI: 10.1007/s10552-022-01620-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 08/09/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Medicare requires tobacco dependence counseling and shared decision-making (SDM) for lung cancer screening (LCS) reimbursement. We hypothesized that initiating SDM during inpatient tobacco treatment visits would increase LCS among patients with barriers to proactively seeking outpatient preventive care. METHODS We collected baseline assessments and performed two pilot randomized trials at our safety-net hospital. Pilot 1 tested feasibility, acceptability, and preliminary efficacy of a nurse practitioner initiating SDM for LCS during hospitalization (Inpatient SDM). We collected qualitative data on barriers encountered during Pilot 1. Pilot 2 added a community health worker (CHW) to address barriers to LCS completion (Inpatient SDM + CHW-navigation). For both studies, preliminary efficacy was an intention-to-treat analysis of LCS completion at 3 months between intervention and comparator (furnishing of LCS decision aid only) groups. RESULTS Baseline assessments showed that patients preferred in-person LCS discussions versus self-reviewing materials; overall 20% had difficulty understanding written information. In Pilot 1, 4% (2/52) in Inpatient SDM versus 2% (1/48, comparator) completed LCS (p = 0.6), despite 89% (89/100) desiring LCS. Primary care providers noted that competing priorities and patient factors (e.g., social barriers to keeping appointments) prevented the intervention from working as intended. In Pilot 2, 50% (5/10) in Inpatient SDM + CHW-navigation versus 9% (1/11, comparator) completed LCS (p < 0.05). Many patients were ineligible due to recent diagnostic chest CT (Pilot 1: 255/659; Pilot 2: 239/527). CONCLUSIONS Inpatient SDM + CHW-navigation shows promise to improve LCS rates among underserved patients who smoke, but feasibility is limited by recent diagnostic chest CT among inpatients. Implementing CHW-navigation in other clinical settings may facilitate LCS for underserved patients. TRAIL REGISTRATION ClinicalTrials.gov Identifier: NCT03276806 (8 September 2017); NCT03793894 (4 January 2019).
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24
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Abubaker-Sharif M, Shusted C, Myers P, Myers R. Primary Care Physician Perceptions of Shared Decision Making in Lung Cancer Screening. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1099-1107. [PMID: 33230673 DOI: 10.1007/s13187-020-01925-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 06/11/2023]
Abstract
The Centers for Medicare and Medicaid Services (CMS) supports lung cancer screening (LCS) with annual low-dose computed tomography (LDCT) for patients who undergo shared decision-making (SDM) about LCS. Unfortunately, SDM and LCS rates are low in primary care, and, as a result, the potential benefits of LCS are not being realized. The research team interviewed 16 primary care physicians in a large urban medical center (7 in Family and Community Medicine and 9 in Internal Medicine) on their views of SDM and LCS. Interview audio-recordings were transcribed. Coders analyzed the interview transcripts independently using direct content analysis to identify major themes and subthemes. Results of interview analyses show that physicians were aware of LCS but believed that they and their patients would benefit from receiving more information about screening guidelines. Physicians knew about SDM and felt that SDM performance could help to identify issues that are important to patients and may affect their receptivity to LCS. However, many physicians expressed concerns about the time required for SDM and completing SDM about LCS when other issues need to be addressed. They also acknowledged the challenge of engaging patients, especially those with low health literacy, in SDM. In practice, some physicians reported instead of engaging eligible patients in SDM, they simply encourage them to screen. Importantly, most physicians said that they would like to receive training in SDM. Findings from this study indicate that primary care physicians support the dissemination of information about LCS and understand the importance of SDM. Physicians also feel that performing SDM in routine care is challenging but are receptive to additional training in SDM. Health systems should take steps to support SDM and LCS performance in primary care.
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Affiliation(s)
| | - Christine Shusted
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, The Jane and Leonard Korman Respiratory Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Pamela Myers
- Division of Population Science, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, 19107, USA.
| | - Ronald Myers
- Division of Population Science, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, 19107, USA
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Wells KJ, Wightman P, Cobian Aguilar R, Dwyer AJ, Garcia-Alcaraz C, Saavedra Ferrer EL, Mohan P, Fleisher L, Franklin EF, Valverde PA, Calhoun E. Comparing clinical and nonclinical cancer patient navigators: A national study in the United States. Cancer 2022; 128 Suppl 13:2601-2609. [PMID: 35699618 DOI: 10.1002/cncr.33880] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 06/08/2021] [Accepted: 07/30/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND A nationwide survey was conducted to examine differences between clinical and nonclinical oncology navigators in their service provision, engagement in the cancer care continuum, personal characteristics, and program characteristics. METHODS Using convenience sampling, 527 oncology navigators participated and completed an online survey. Descriptive statistics, χ2 statistics, and t tests were used to compare nonclinical (eg, community health worker) and clinical (eg, nurse navigators) navigators on the provision of various navigation services, personal characteristics, engagement in the cancer care continuum, and program characteristics. RESULTS Most participants were clinical navigators (76.1%). Compared to nonclinical navigators, clinical navigators were more likely to have a bachelor's degree or higher (88.6% vs 69.6%, P < .001), be funded by operational budgets (84.4% vs 35.7%, P < .001), and less likely to work at a community-based organization or nonprofit (2.0% vs 36.5%, P < .001). Clinical navigators were more likely to perform basic navigation (P < .001), care coordination (P < .001), treatment support (P < .001), and clinical trial/peer support (P = .005). Clinical navigators were more likely to engage in treatment (P < .001), end-of-life (P < .001), and palliative care (P = .001) navigation. CONCLUSIONS There is growing indication that clinical and nonclinical oncology navigators perform different functions and work in different settings. Nonclinical navigators may be more likely to face job insecurity because they work in nonprofit organizations and are primarily funded by grants.
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Affiliation(s)
- Kristen J Wells
- Department of Psychology, San Diego State University, San Diego, California.,San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | | | | | | | - Cristian Garcia-Alcaraz
- Department of Psychology, San Diego State University, San Diego, California.,San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
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Sakoda LC, Gould MK. Facilitating Adherence to Annual Screening for Lung Cancer. Chest 2022; 162:8-10. [DOI: 10.1016/j.chest.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/15/2022] [Indexed: 10/17/2022] Open
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Holman A, Kross E, Crothers K, Cole A, Wernli K, Triplette M. Patient Perspectives on Longitudinal Adherence to Lung Cancer Screening. Chest 2022; 162:230-241. [PMID: 35149081 DOI: 10.1016/j.chest.2022.01.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Annual lung cancer screening (LCS) has mortality benefits for eligible participants; however, studies demonstrate low adherence to follow-up LCS. RESEARCH QUESTION What are patients' perspectives on barriers and facilitators to adherence to annual LCS? STUDY DESIGN AND METHODS Forty participants enrolled in the University of Washington/Seattle Cancer Care Alliance LCS program completed a demographic questionnaire and a semistructured interview based on the Tailored Implementation in Chronic Diseases framework to determine attitudes, barriers, and facilitators to longitudinal LCS. Interviews were coded using principles of framework analysis to identify and compare themes between adherent and nonadherent participants. RESULTS The 40 participants underwent initial LCS in 2017 with negative results. Seventeen were adherent to follow-up annual LCS, whereas 23 were not. Seven overall themes emerged from qualitative analysis, which are summarized as follows: (1) screening experiences are positive and participants have positive attitudes toward screening; (2) provider recommendation is a motivator and key facilitator for most patients; (3) many patients are influenced by personal factors and symptoms and do not understand the importance of asymptomatic screening; (4) common barriers to longitudinal screening include cost, insurance coverage, accessibility, and other medical conditions; (5) patients have variable preferences about how they receive their screening results, and many have residual questions about their results and future screening; (6) reminders are an important facilitator of annual screening; and (7) most patients think a navigator would be beneficial to the screening process, with different aspects of navigation thought to be most helpful. Those who were not adherent more commonly reported individual barriers to screening, competing health concerns, and less provider communication. INTERPRETATION Key facilitators (eg, patient reminders, provider recommendations) may improve long-term screening behavior, and a number of barriers to the screening process could be addressed through patient navigation.
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Affiliation(s)
- Anna Holman
- School of Medicine and Department of Medicine, University of Washington, Seattle, WA
| | - Erin Kross
- School of Medicine and Department of Medicine, University of Washington, Seattle, WA
| | - Kristina Crothers
- School of Medicine and Department of Medicine, University of Washington, Seattle, WA; Veterans Affairs Puget Sound Health Care System, Seattle, WA
| | - Allison Cole
- Department of Family Medicine, University of Washington, Seattle, WA
| | - Karen Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Matthew Triplette
- School of Medicine and Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
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Referring high-risk individuals for lung cancer screening: A systematic review of interventions with healthcare professionals. Eur J Cancer Prev 2022; 31:540-550. [PMID: 35383631 DOI: 10.1097/cej.0000000000000755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This systematic review described the effect of interventions aimed at helping Healthcare Professionals refer high-risk individuals for lung cancer screening. Primary outcomes included: patient outcomes such as lung cancer detection, screening for lung cancer, lung cancer treatments received and lung cancer mortality. Healthcare professionals' knowledge and awareness of lung cancer screening served as secondary outcomes. METHODS Experimental studies published between January 2016 and 2021 were included. The search was conducted in MEDLINE, CINAHL, ERIC, PsycARTICLES, PsycInfo and Psychology and Behavioral Sciences Collection. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool and the level of evidence was assessed using the Scottish Intercollegiate Guidelines Network grading system. RESULTS Nine studies were included. Nurse navigation, electronic prompts for lung cancer screening and shared decision-making helped improve patient outcomes. Specialist screenings yielded more significant incidental findings and a higher percentage of Lung-RADS 1 results (i.e. no nodules/definitely benign nodules), while Primary Care Physician screenings were associated with higher numbers of Lung-RADS 2 results (i.e. benign nodules with a very low likelihood to becoming malignant). An increase in Healthcare Professionals' knowledge and awareness of lung cancer screening was achieved using group-based learning compared to lecture-based education delivery. CONCLUSIONS The effectiveness of Nurse navigation is evident, as are the benefits of adequate training, shared decision-making, as well as a structured, clear and well-understood referral processes supported by the use of electronic system-incorporated prompts.
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29
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Improving Lung Cancer Screening Rates Through an Evidence-Based Electronic Health Record Smoking History. J Nurs Care Qual 2022; 37:263-268. [PMID: 35380553 DOI: 10.1097/ncq.0000000000000623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Lung cancer is prevalent worldwide, with 2.1 million new cases and 1.8 million deaths in 2020. In the United States, an estimated 131 880 lung cancer deaths are expected to occur in 2021, with most detected in later stages. Smokers are 15 to 30 times more likely to develop or die from lung cancer. LOCAL PROBLEM Our community residents were more likely to be diagnosed with lung cancer in later stages (62%) compared with 56% nationally, resulting in an increased community mortality rate. INTERVENTION Evidence-based changes in an electronic health record system supported identification and referral of high-risk patients for low-dose computer tomography to improve early lung cancer detection rates. RESULTS Early-stage lung cancer detection increased 24%. CONCLUSIONS Interprofessional teams used technology to adopt evidence-based practice and improve health outcomes in their communities.
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Narayan AK, Chowdhry DN, Fintelmann FJ, Little BP, Shepard JAO, Flores EJ. Racial and Ethnic Disparities in Lung Cancer Screening Eligibility. Radiology 2021; 301:712-720. [PMID: 34546133 DOI: 10.1148/radiol.2021204691] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background To address disparities in lung cancer screening (LCS) that may exclude large numbers of high-risk African American smokers, revised U.S. Preventive Services Task Force (USPSTF) recommendations lowered LCS eligibility thresholds. However, there are limited recent data about the impact of newly revised guidelines on disparities in LCS eligibility. Purpose To evaluate the impact of revised USPSTF guidelines on racial and ethnic disparities in LCS eligibility. Materials and Methods Cross-sectional survey data from 20 states were retrospectively evaluated from the 2019 Behavioral Risk Factor Surveillance System survey (median response rate, 49.4%). Respondents without a history of lung cancer aged 55-79 years (ie, under the previous guidelines) or aged 50-79 years (ie, under the revised guidelines) were included. Multivariable logistic regression analyses were performed to evaluate the association between race and ethnicity and LCS eligibility. All analyses were performed accounting for complex survey design features (ie, weighting, stratification, and clustering). Results Under previous guidelines, 11% of 67 567 weighted survey respondents were eligible for LCS (White [12%], Hispanic [4%], African American [7%], American Indian [17%], Asian or Pacific Islander [4%], and other [12%]). Under revised USPSTF guidelines, 14% of 77 689 weighted survey respondents were eligible for LCS (White [15%], Hispanic [5%], African American [9%], American Indian [21%), Asian or Pacific Islander [5%], and other [18%]). Compared with White respondents, African American respondents (adjusted odds ratio [OR] = 0.36; 95% CI: 0.27, 0.47; P < .001) and Hispanic respondents (adjusted OR = 0.15; 95% CI: 0.09, 0.24; P < .001) were less likely to be eligible for LCS under previous guidelines. African American respondents (adjusted OR = 0.39; 95% CI: 0.32, 0.47; P < .001) and Hispanic respondents (adjusted OR = 0.15; 95% CI: 0.10, 0.23; P < .001) were less likely to be eligible under the revised guidelines. The Wald test showed no evidence of differences in the degree to which racial and ethnic minority groups were less likely to be eligible for LCS when comparing previous versus revised USPSTF guidelines (P = .76). Conclusion The revised U.S. Preventive Services Task Force guidelines (version 2.0) may perpetuate lung cancer disparities, as racial and ethnic minority groups are still less likely to be eligible for lung cancer screening. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Jacobs and Springfield in this issue.
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Affiliation(s)
- Anand K Narayan
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Wang 219H, Boston, MA 02114
| | - Divya N Chowdhry
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Wang 219H, Boston, MA 02114
| | - Florian J Fintelmann
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Wang 219H, Boston, MA 02114
| | - Brent P Little
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Wang 219H, Boston, MA 02114
| | - Jo-Anne O Shepard
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Wang 219H, Boston, MA 02114
| | - Efrén J Flores
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Wang 219H, Boston, MA 02114
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Myers RE. Health Organizations Have an Opportunity to Improve Shared Decision-Making and Raise Lung Cancer Screening Rates. Chest 2021; 159:23-24. [PMID: 33422199 DOI: 10.1016/j.chest.2020.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 09/29/2020] [Accepted: 10/16/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ronald E Myers
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Dresher, PA.
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Castro S, Sosa E, Lozano V, Akhtar A, Love K, Duffels J, Raz DJ, Kim JY, Sun V, Erhunmwunsee L. The impact of income and education on lung cancer screening utilization, eligibility, and outcomes: a narrative review of socioeconomic disparities in lung cancer screening. J Thorac Dis 2021; 13:3745-3757. [PMID: 34277066 PMCID: PMC8264678 DOI: 10.21037/jtd-20-3281] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/04/2021] [Indexed: 12/12/2022]
Abstract
Non-small cell lung cancer (NSCLC) is the leading cause of cancer deaths in the US and worldwide. In particular, vulnerable populations such as those of low socioeconomic status (SES) are at the highest risk for and suffer the highest mortality from NSCLC. Although lung cancer screening (LCS) has been demonstrated to be a powerful tool to lower NSCLC mortality, it is underutilized by eligible smokers, and disparities in screening are likely to contribute to inequities in NSCLC outcomes. It is imperative that we collect and analyze LCS data focused on individuals of low socioeconomic position to identify and address barriers to LCS utilization and help close the gaps in NSCLC mortality along socioeconomic lines. Toward this end, this review aims to examine published studies that have evaluated the impact of income and education on LCS utilization, eligibility, and outcomes. We searched the PubMed, Ovid MEDLINE, and CINAHL Plus databases for all studies published from January 1, 2010, to October 21, 2020, that discussed socioeconomic-based LCS outcomes. The review reveals that income and education have impact on LCS utilization, eligibility, false positive rates and smoking cessation attempts; however, there is a lack of studies evaluating the impact of SES on LCS follow-up, stage at diagnosis, and treatment. We recommend the intentional inclusion of lower SES participants in LCS studies in order to clarify appropriate eligibility criteria, risk-based metrics and outcomes in this high-risk group. We also anticipate that low SES smokers and their providers will require increased support and education regarding smoking cessation and shared decision-making efforts.
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Affiliation(s)
- Samuel Castro
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Ernesto Sosa
- Department of Populations Sciences, City of Hope National Medical Center, Duarte, CA, USA
| | - Vanessa Lozano
- Department of Populations Sciences, City of Hope National Medical Center, Duarte, CA, USA
| | - Aamna Akhtar
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Kyra Love
- Library Services, City of Hope National Medical Center, Duarte, CA, USA
| | - Jeanette Duffels
- Library Services, City of Hope National Medical Center, Duarte, CA, USA
| | - Dan J Raz
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Jae Y Kim
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Virginia Sun
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.,Department of Populations Sciences, City of Hope National Medical Center, Duarte, CA, USA
| | - Loretta Erhunmwunsee
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.,Department of Populations Sciences, City of Hope National Medical Center, Duarte, CA, USA
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Van Hal G, Diab Garcia P. Lung cancer screening: targeting the hard to reach-a review. Transl Lung Cancer Res 2021; 10:2309-2322. [PMID: 34164279 PMCID: PMC8182716 DOI: 10.21037/tlcr-20-525] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/19/2020] [Indexed: 12/28/2022]
Abstract
Lung cancer (LC) is the leading cause of cancer death in the USA for both men and women, and also worldwide, it is the commonest cause of cancer death. The five-year survival rate for LC depends on the stage at which it is diagnosed. It is over 50% for cases detected in a localized stage but when the disease has spread to other organs, the five-year survival rate is only 5%. Unfortunately, only 16% of LC cases are diagnosed at an early stage. In 2013, the US Preventive Services Task Force (USPSTF) recommended annual LC screening with low dose chest computed tomography (CT) in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years, based on the evidence from the National Lung Screening Trial (NLST) in the USA. When it comes to recruiting the target group for lung cancer screening (LCS), there are several barriers to overcome, such as whom exactly to include, where to find the target group, how to convince the target to participate or how to attract participants from all socioeconomic groups. The aim of this review is to find out what is already known about how the target group for LCS can be contacted and how participation can be improved, since uptake is a key issue in every (cancer) screening program. A review of the literature was conducted using 'lung cancer screening and participation and uptake' as search string. We searched in Web of Science and PubMed for reviews, systematic reviews and articles, published between 2015 and 2020. Compared to the target groups for screening in the long-running cancer screening programs of breast, cervical and colorectal cancer, there are several additional obstacles regarding defining, locating and recruiting of the target group for LCS. Shared decision-making is crucial when we want to reach the hard to reach for LCS and it should be improved, by educating primary care practitioners about LCS guidelines and providing them with the necessary tools, such as decision aids, to facilitate their job in this respect. Moreover, the information materials should be more tailored to specific groups who participate least.
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Affiliation(s)
- Guido Van Hal
- Department of Social Epidemiology and Health Policy, University of Antwerp, Belgium, Antwerpen, Belgium
| | - Paloma Diab Garcia
- Department of Social Epidemiology and Health Policy, University of Antwerp, Belgium, Antwerpen, Belgium
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The Impact of Smoking and Screening Results on Adherence to Follow-Up in an Academic Multisite Lung Cancer Screening Program. Ann Am Thorac Soc 2021; 18:545-547. [DOI: 10.1513/annalsats.202006-631rl] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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35
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Rivera MP, Katki HA, Tanner NT, Triplette M, Sakoda LC, Wiener RS, Cardarelli R, Carter-Harris L, Crothers K, Fathi JT, Ford ME, Smith R, Winn RA, Wisnivesky JP, Henderson LM, Aldrich MC. Addressing Disparities in Lung Cancer Screening Eligibility and Healthcare Access. An Official American Thoracic Society Statement. Am J Respir Crit Care Med 2020; 202:e95-e112. [PMID: 33000953 PMCID: PMC7528802 DOI: 10.1164/rccm.202008-3053st] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: There are well-documented disparities in lung cancer outcomes across populations. Lung cancer screening (LCS) has the potential to reduce lung cancer mortality, but for this benefit to be realized by all high-risk groups, there must be careful attention to ensuring equitable access to this lifesaving preventive health measure.Objectives: To outline current knowledge on disparities in eligibility criteria for, access to, and implementation of LCS, and to develop an official American Thoracic Society statement to propose strategies to optimize current screening guidelines and resource allocation for equitable LCS implementation and dissemination.Methods: A multidisciplinary panel with expertise in LCS, implementation science, primary care, pulmonology, health behavior, smoking cessation, epidemiology, and disparities research was convened. Participants reviewed available literature on historical disparities in cancer screening and emerging evidence of disparities in LCS.Results: Existing LCS guidelines do not consider racial, ethnic, socioeconomic, and sex-based differences in smoking behaviors or lung cancer risk. Multiple barriers, including access to screening and cost, further contribute to the inequities in implementation and dissemination of LCS.Conclusions: This statement identifies the impact of LCS eligibility criteria on vulnerable populations who are at increased risk of lung cancer but do not meet eligibility criteria for screening, as well as multiple barriers that contribute to disparities in LCS implementation. Strategies to improve the selection and dissemination of LCS in vulnerable groups are described.
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Abstract
Tobacco dependence is the most consequential target to reduce the burden of lung cancer worldwide. Quitting after a cancer diagnosis can improve cancer prognosis, overall health, and quality of life. Several oncology professional organizations have issued guidelines stressing the importance of tobacco treatment for patients with cancer. Providing tobacco treatment in the context of lung cancer screening is another opportunity to further reduce death from lung cancer. In this review, the authors describe the current state of tobacco dependence treatment focusing on new paradigms and approaches and their particular relevance for persons at risk or on treatment for lung cancer.
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Stowell JT, Narayan AK, Wang GX, Fintelmann FJ, Flores EJ, Sharma A, Petranovic M, Shepard JAO, Little BP. Factors affecting patient adherence to lung cancer screening: A multisite analysis. J Med Screen 2020; 28:357-364. [PMID: 32847462 DOI: 10.1177/0969141320950783] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To identify factors associated with delayed adherence to follow-up in lung cancer screening. METHODS Utilizing a data warehouse and lung cancer screening registry, variables were collected from a referred sample of 3110 unique participants with follow-up CT during the study period (1 January 2016 to 17 October 2018). Adherence was defined as undergoing chest CT within 90 days and 30 days of the recommended time for follow-up and was determined using proportions and multiple variable logistic regression models across the American College of Radiology Lung Imaging Reporting and Data System (Lung-RADS®) categories. RESULTS Of 1954 lung cancer screening participants (51.9% (1014/1954) males, 48.1% (940/1954) female; mean age 65.7 (range 45-87), smoking history median 40 pack-years, 60.2% and 44.5% did not follow-up within 30 and 90 days, respectively. Participants receiving Lung-RADS® category 1 or 2 presented later than those with Lung-RADS® category 3 at 90 days (coefficient -27.24, 95% CI -51.31, -3.16, p = 0.027). Participants with Lung-RADS® category 1 presented later than those with Lung-RADS® category 2 at both 90- and 30-days past due (OR 0.76 95% CI [0.59-0.97], p = 0.029 and OR 0.63 95% CI [0.48-0.83], p = 0.001, respectively). CONCLUSIONS Adherence to follow-up was higher among participants receiving more suspicious Lung-RADS® results at index screening CT and among those who had undergone more non-lung cancer screening imaging examinations prior to index lung cancer screening CT. These observations may inform strategies aimed at prospectively identifying participants at risk for delayed or nonadherence to prevent potential morbidity and mortality from incident lung cancers.
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Affiliation(s)
| | - Anand K Narayan
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Gary X Wang
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Efren J Flores
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Amita Sharma
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Milena Petranovic
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jo-Anne O Shepard
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Brent P Little
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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Steiling K, Loui T, Asokan S, Nims S, Moreira P, Rebello A, Litle VR, Suzuki K. Age, Race, and Income Are Associated With Lower Screening Rates at a Safety Net Hospital. Ann Thorac Surg 2020; 109:1544-1550. [PMID: 31981498 DOI: 10.1016/j.athoracsur.2019.11.052] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 11/13/2019] [Accepted: 11/25/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND While lung cancer screening improves cancer-specific mortality and is recommended for high-risk patients, barriers to screening still exist. We sought to determine our institution's (an urban safety net hospital) screening rate and to identify socioeconomic barriers to lung cancer screening. METHODS We identified 8935 smokers 55 to 80 years of age evaluated by a primary care physician between March 2015 and March 2017 at our institution. We randomly selected one-third of these (n = 2978) to review for eligibility using the U.S. Preventive Services Task Force criteria for lung cancer screening. Using our institution's Lung Cancer Screening Program clinical tracking database, we identified patients who were screened from March 2015 to March 2017. We collected demographic information (race, primary language, education status, and median income) and evaluated possible associations with screening. RESULTS Among our institution population, 99 patients meeting U.S. Preventive Services Task Force screening criteria underwent screening computed tomography, whereas 516 eligible patients were not screened, making our institution's estimated screening rate 16.1%. Comparing the unscreened population with those who received screening at our institution, the unscreened population was significantly older (median age of screened patients was 63 years, of unscreened patients was 66 years; P < .001). African Americans had a lower screening rate (37.6% of the screened population and 47.5% of the unscreened population; P < .001). Unscreened patients had a lower annual household income. CONCLUSIONS The lung cancer screening rate at our hospital is 16.1%. Unscreened patients were older, were more likely to be African American, and had a lower median income. These findings highlight possible screening barriers and potential areas for targeted strategies to decrease disparities in lung cancer screening.
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Affiliation(s)
- Katrina Steiling
- Division of Pulmonary, Allergy, Sleep and Critical Care Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts; Division of Computational Biomedicine Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Taylor Loui
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Sainath Asokan
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Sarah Nims
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Paulo Moreira
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Anuradha Rebello
- Department of Radiology, Boston University School of Medicine, Boston, Massachusetts
| | - Virginia R Litle
- Division of Thoracic Surgery, Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Kei Suzuki
- Division of Thoracic Surgery, Department of Surgery, Boston University School of Medicine, Boston, Massachusetts.
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Impact of Primary Care Physician Interaction on Longitudinal Adherence to Screening Mammography Across Different Racial/Ethnic Groups. J Am Coll Radiol 2019; 16:908-914. [DOI: 10.1016/j.jacr.2018.12.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/12/2018] [Accepted: 12/15/2018] [Indexed: 12/28/2022]
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López DB, Flores EJ, Miles RC, Wang GX, Glover M, Shepard JAO, Lehman CD, Narayan AK. Assessing Eligibility for Lung Cancer Screening Among Women Undergoing Screening Mammography: Cross-Sectional Survey Results From the National Health Interview Survey. J Am Coll Radiol 2019; 16:1433-1439. [PMID: 31092347 DOI: 10.1016/j.jacr.2019.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/07/2019] [Accepted: 04/08/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Millions of women undergo mammography screening each year, presenting an opportunity for radiologists to identify women eligible for lung cancer screening (LCS) with low-dose chest CT and smoking cessation counseling. The purpose of our study was to estimate the proportion of women eligible for LCS and tobacco cessation counseling among women reporting mammography screening within the previous 2 years using nationally representative cross-sectional survey data. METHODS Women between the ages of 55 and 74 years in the 2015 National Health Interview Survey without history of lung or breast cancer who reported mammography use in the previous 2 years were included. The primary outcome was the weighted proportion of women eligible for LCS. Secondary outcomes included self-reported receipt of LCS and current smoking. Bivariate and multiple variable logistic regression analyses were performed to evaluate the association between primary and secondary outcomes and sociodemographics, accounting for complex survey design elements. RESULTS Among 3,806 women meeting inclusion criteria, 7.1% were eligible for LCS and 9.8% were current smokers. Multivariable analyses demonstrated that LCS-eligible women were more likely to be white, younger, and non-college-educated and have lower household incomes (all P < .001). Among all LCS-eligible women, 58% reported undergoing mammography screening within the previous 2 years. Among LCS-eligible women who underwent screening mammography, 7.9% reported undergoing LCS. CONCLUSIONS The majority of LCS-eligible women received mammography screening but did not receive LCS. Mammography encounters may represent prime opportunities to increase LCS participation among patients already receiving imaging-based screening services.
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Affiliation(s)
| | - Efrén J Flores
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Randy C Miles
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gary X Wang
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - McKinley Glover
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Massachusetts General Physicians Organization, Boston, Massachusetts
| | - Jo-Anne O Shepard
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Constance D Lehman
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anand K Narayan
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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Wiener RS, Rivera MP. Access to Lung Cancer Screening Programs in the United States. Chest 2019; 155:883-885. [DOI: 10.1016/j.chest.2019.01.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/16/2019] [Indexed: 10/26/2022] Open
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Triplette M, Thayer JH, Pipavath SN, Crothers K. Poor Uptake of Lung Cancer Screening: Opportunities for Improvement. J Am Coll Radiol 2019; 16:446-450. [DOI: 10.1016/j.jacr.2018.12.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/04/2018] [Accepted: 12/14/2018] [Indexed: 12/11/2022]
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Wang GX, Baggett TP, Pandharipande PV, Park ER, Percac-Lima S, Shepard JAO, Fintelmann FJ, Flores EJ. Barriers to Lung Cancer Screening Engagement from the Patient and Provider Perspective. Radiology 2019; 290:278-287. [PMID: 30620258 DOI: 10.1148/radiol.2018180212] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Lung cancer remains the leading cause of cancer mortality in the United States. Lung cancer screening (LCS) with low-dose CT reduces mortality among high-risk current and former smokers and has been covered by public and private insurers without cost sharing since 2015. Patients and referring providers confront numerous barriers to participation in screening. To best serve in multidisciplinary efforts to expand LCS nationwide, radiologists must be knowledgeable of these challenges. A better understanding of the difficulties confronted by other stakeholders will help radiologists continue to collaboratively guide the growth of LCS programs in their communities. This article reviews barriers to participation in LCS for patients and referring providers, as well as possible solutions and interventions currently underway.
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Affiliation(s)
- Gary X Wang
- From the Department of Radiology (G.X.W., P.V.P., J.O.S., F.J.F., E.J.F.), Division of General Internal Medicine (T.P.B., S.P.L.), and Department of Psychiatry (E.R.P.), Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Founders 202, Boston, MA 02114; and Institute for Technology Assessment (P.V.P.), Mongan Institute Health Policy Center (E.R.P.), and Tobacco Research and Treatment Center (E.R.P., T.P.B.), Massachusetts General Hospital, Boston, Mass
| | - Travis P Baggett
- From the Department of Radiology (G.X.W., P.V.P., J.O.S., F.J.F., E.J.F.), Division of General Internal Medicine (T.P.B., S.P.L.), and Department of Psychiatry (E.R.P.), Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Founders 202, Boston, MA 02114; and Institute for Technology Assessment (P.V.P.), Mongan Institute Health Policy Center (E.R.P.), and Tobacco Research and Treatment Center (E.R.P., T.P.B.), Massachusetts General Hospital, Boston, Mass
| | - Pari V Pandharipande
- From the Department of Radiology (G.X.W., P.V.P., J.O.S., F.J.F., E.J.F.), Division of General Internal Medicine (T.P.B., S.P.L.), and Department of Psychiatry (E.R.P.), Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Founders 202, Boston, MA 02114; and Institute for Technology Assessment (P.V.P.), Mongan Institute Health Policy Center (E.R.P.), and Tobacco Research and Treatment Center (E.R.P., T.P.B.), Massachusetts General Hospital, Boston, Mass
| | - Elyse R Park
- From the Department of Radiology (G.X.W., P.V.P., J.O.S., F.J.F., E.J.F.), Division of General Internal Medicine (T.P.B., S.P.L.), and Department of Psychiatry (E.R.P.), Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Founders 202, Boston, MA 02114; and Institute for Technology Assessment (P.V.P.), Mongan Institute Health Policy Center (E.R.P.), and Tobacco Research and Treatment Center (E.R.P., T.P.B.), Massachusetts General Hospital, Boston, Mass
| | - Sanja Percac-Lima
- From the Department of Radiology (G.X.W., P.V.P., J.O.S., F.J.F., E.J.F.), Division of General Internal Medicine (T.P.B., S.P.L.), and Department of Psychiatry (E.R.P.), Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Founders 202, Boston, MA 02114; and Institute for Technology Assessment (P.V.P.), Mongan Institute Health Policy Center (E.R.P.), and Tobacco Research and Treatment Center (E.R.P., T.P.B.), Massachusetts General Hospital, Boston, Mass
| | - Jo-Anne O Shepard
- From the Department of Radiology (G.X.W., P.V.P., J.O.S., F.J.F., E.J.F.), Division of General Internal Medicine (T.P.B., S.P.L.), and Department of Psychiatry (E.R.P.), Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Founders 202, Boston, MA 02114; and Institute for Technology Assessment (P.V.P.), Mongan Institute Health Policy Center (E.R.P.), and Tobacco Research and Treatment Center (E.R.P., T.P.B.), Massachusetts General Hospital, Boston, Mass
| | - Florian J Fintelmann
- From the Department of Radiology (G.X.W., P.V.P., J.O.S., F.J.F., E.J.F.), Division of General Internal Medicine (T.P.B., S.P.L.), and Department of Psychiatry (E.R.P.), Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Founders 202, Boston, MA 02114; and Institute for Technology Assessment (P.V.P.), Mongan Institute Health Policy Center (E.R.P.), and Tobacco Research and Treatment Center (E.R.P., T.P.B.), Massachusetts General Hospital, Boston, Mass
| | - Efren J Flores
- From the Department of Radiology (G.X.W., P.V.P., J.O.S., F.J.F., E.J.F.), Division of General Internal Medicine (T.P.B., S.P.L.), and Department of Psychiatry (E.R.P.), Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Founders 202, Boston, MA 02114; and Institute for Technology Assessment (P.V.P.), Mongan Institute Health Policy Center (E.R.P.), and Tobacco Research and Treatment Center (E.R.P., T.P.B.), Massachusetts General Hospital, Boston, Mass
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Shusted CS, Barta JA, Lake M, Brawer R, Ruane B, Giamboy TE, Sundaram B, Evans NR, Myers RE, Kane GC. The Case for Patient Navigation in Lung Cancer Screening in Vulnerable Populations: A Systematic Review. Popul Health Manag 2018; 22:347-361. [PMID: 30407102 PMCID: PMC6685525 DOI: 10.1089/pop.2018.0128] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Patient navigation has been proposed to combat cancer disparities in vulnerable populations. Vulnerable populations often have poorer cancer outcomes and lower levels of screening, adherence, and treatment. Navigation has been studied in various cancers, but few studies have assessed navigation in lung cancer. Additionally, there is a lack of consistency in metrics to assess the quality of navigation programs. The authors conducted a systematic review of published cancer screening studies to identify quality metrics used in navigation programs, as well as to recommend standardized metrics to define excellence in lung cancer navigation. The authors included 26 studies evaluating navigation metrics in breast, cervical, colorectal, prostate, and lung cancer. After reviewing the literature, the authors propose the following navigation metrics for lung cancer screening programs: (1) screening rate, (2) compliance with follow-up, (3) time to treatment initiation, (4) patient satisfaction, (5) quality of life, (6) biopsy complications, and (7) cultural competency.
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Affiliation(s)
- Christine S Shusted
- 1Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Julie A Barta
- 2Division of Pulmonary and Critical Care, The Jane and Leonard Korman Respiratory Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael Lake
- 2Division of Pulmonary and Critical Care, The Jane and Leonard Korman Respiratory Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rickie Brawer
- 3Department of Family & Community Medicine, Sidney Kimmel Medical College, Center for Urban Health, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Brooke Ruane
- 4Division of Pulmonary and Critical Care, The Jane and Leonard Korman Respiratory Institute, Philadelphia, Pennsylvania
| | - Teresa E Giamboy
- 5Tobacco Dependence Program, Jefferson Health - Northeast, Philadelphia, Pennsylvania
| | - Baskaran Sundaram
- 6Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Nathaniel R Evans
- 7Division of Thoracic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ronald E Myers
- 8Division of Population Science and Center for Health Decisions, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gregory C Kane
- 9Department of Medicine, Division of Pulmonary and Critical Care, The Jane and Leonard Korman Respiratory Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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