1
|
Fix GM, Kaitz J, Herbst AN, Wiener RS, Crocker D, Miano D, Barker AM. Practical Strategies for Co-design: The Case of Engaging Patients in Developing Patient-Facing Shared-Decision Making Materials for Lung Cancer Screening. J Patient Exp 2024; 11:23743735241252247. [PMID: 38855653 PMCID: PMC11162119 DOI: 10.1177/23743735241252247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
Co-design provides a meaningful way to engage patients in research. However, there is limited practical guidance. We used our co-design project to identify strategies for other researchers. An ethnographic case study design was used. Data included participant observation of co-design meetings, meeting minutes, analytic fieldnotes, qualitative patient interviews, and research team member self-reflections. Additionally, we got external feedback. We analyzed data iteratively. Our team included 5 patients and 6 researchers. We identified 3 strategies to include patients in co-design: (1) Deliberately build the team, from recruiting patients to specifying roles. (2) Tailor the meeting format to thoughtfully use patients' time and expertise. (3) Disrupt traditional hierarchies, to empower patients to actively participate. Researchers seeking to include patients as team members should consider: team composition and roles, leveraging meeting formats to optimize contributions and purposefully creating a culture of collaboration, so patient expertise informs the end product. Our work provides practical guidance for researchers to incorporate patient expertise in the co-design process and meaningfully involve them in their work.
Collapse
Affiliation(s)
- Gemmae M. Fix
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford and VA Boston Healthcare System, Bedford/Boston, MA, USA
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jenesse Kaitz
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford and VA Boston Healthcare System, Bedford/Boston, MA, USA
- Sleep Medicine, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Abigail N. Herbst
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford and VA Boston Healthcare System, Bedford/Boston, MA, USA
| | - Renda Soylemez Wiener
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford and VA Boston Healthcare System, Bedford/Boston, MA, USA
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC, USA
- The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Dave Crocker
- Veteran Consultant Network, CHOIR Bedford Veteran Consultant Network, Bedford, MA, USA
| | - Dani Miano
- Methodist Healthcare System, San Antonio, TX, USA
| | - Anna M. Barker
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford and VA Boston Healthcare System, Bedford/Boston, MA, USA
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Núñez ER, Fukunaga MI, 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:S0012-3692(24)00654-8. [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] [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.
Collapse
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
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
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)
| | | | | | | | | | | | | | | |
Collapse
|
6
|
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.
Collapse
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.
| |
Collapse
|
7
|
Cho HL, Perni S, D'Amico AV, Yamoah K, Dee EC. The imperative for clinical trial diversity: Perspectives in the context of prostate-specific membrane antigen-targeted imaging. Prostate Cancer Prostatic Dis 2023; 26:511-515. [PMID: 36872319 DOI: 10.1038/s41391-023-00657-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/15/2023] [Accepted: 02/23/2023] [Indexed: 03/07/2023]
Affiliation(s)
| | - Subha Perni
- Departments of Radiation Oncology and Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anthony V D'Amico
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
| | - Kosj Yamoah
- Department of Radiation Oncology, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
8
|
Bouchard EG, Saad-Harfouche FG, Clark N, Colon J, LaValley SA, Reid M, Attwood K, Bansal-Travers M, Glaser K. Adapting Community Educational Programs During the COVID-19 Pandemic: Comparing the Feasibility and Efficacy of a Lung Cancer Screening Educational Intervention by Mode of Delivery. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:854-862. [PMID: 35840859 PMCID: PMC9286703 DOI: 10.1007/s13187-022-02197-1] [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] [Accepted: 06/27/2022] [Indexed: 06/02/2023]
Abstract
Few eligible patients receive lung cancer screening. We developed the Lung AIR (awareness, information, and resources) intervention to increase community education regarding lung cancer screening. The intervention was designed as an in-person group intervention; however, the COVID-19 pandemic necessitated adapting the mode of delivery. In this study we examined intervention feasibility and efficacy overall and by mode of delivery (in-person group vs. one-on-one phone) to understand the impact of adapting community outreach and engagement strategies. Feasibility was examined through participant demographics. Efficacy was measured through pre/post knowledge, attitudes, and beliefs about lung cancer screening, and intention to complete screening. We reached N = 292 participants. Forty percent had a household income below $35,000, 58% had a high school degree or less, 40% were Hispanic, 57% were Black, and 84% reported current or past smoking. One-on-one phone sessions reached participants who were older, had lower incomes, more current smoking, smoked for more years, more cigarettes per day, lower pre-intervention lung cancer screening knowledge, and higher pre-intervention fear and worry. Overall pre/post test scores show significant increases in knowledge, salience, and coherence, and reduced fear and worry. Participants in the one-on-one phone sessions had significantly higher increases in salience and coherence and intention to complete screening compared to participants in the in-person group sessions. The Lung AIR intervention is a feasible and effective community-based educational intervention for lung cancer screening. Findings point to differences in reach and efficacy of the community-based intervention by mode of delivery.
Collapse
Affiliation(s)
- Elizabeth G Bouchard
- Department of Cancer Prevention and Control, Office of Community Outreach and Engagement, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA.
| | - Frances G Saad-Harfouche
- Department of Cancer Prevention and Control, Office of Community Outreach and Engagement, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Nikia Clark
- Department of Cancer Prevention and Control, Office of Community Outreach and Engagement, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Jomary Colon
- Department of Cancer Prevention and Control, Office of Community Outreach and Engagement, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Susan A LaValley
- Department of Cancer Prevention and Control, Office of Community Outreach and Engagement, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Mary Reid
- Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Kristopher Attwood
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Kathryn Glaser
- Department of Cancer Prevention and Control, Office of Community Outreach and Engagement, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| |
Collapse
|
9
|
Dodd RH, Sharman AR, McGregor D, Stone E, Donnelly C, Lourenco RDA, Marshall H, Rankin NM. Education messages and strategies to inform the public, potential screening candidates and healthcare providers about lung cancer screening: A systematic review. Prev Med 2023; 169:107459. [PMID: 36854365 DOI: 10.1016/j.ypmed.2023.107459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/27/2023]
Abstract
International lung cancer screening (LCS) trials, using low-dose computed tomography, have demonstrated clinical effectiveness in reducing mortality from lung cancer. This systematic review aims to synthesise the key messages and strategies that could be successful in increasing awareness and knowledge of LCS, and ultimately increase uptake of screening. Studies were identified via relevant database searches up to January 2022. Two authors evaluated eligible studies, extracted and crosschecked data, and assessed quality. Results were synthesised narratively. Of 3205 titles identified, 116 full text articles were reviewed and 22 studies met the inclusion criteria. Twenty studies were conducted in the United States. While the study findings were heterogenous, key messages mentioned across multiple studies were about: provision of information on LCS and the recommendations for LCS (n = 8); benefits and harms of LCS (n = 6); cost of LCS and insurance coverage for participants (n = 6) and eligibility criteria (n = 5). To increase knowledge and awareness, evidence from awareness campaigns suggests that presenting information about eligibility and the benefits and harms of screening, may increase screening intention and uptake. Evidence from behavioural studies suggests that campaigns supporting engagement with platforms such as educational videos and digital awareness campaigns might be most effective. Group based learning appears to be most suited to increasing health professionals' knowledge. This systematic review found a lack of consistent evidence to demonstrate which strategies are most effective for increasing participant healthcare professional and community awareness and education about LCS.
Collapse
Affiliation(s)
- Rachael H Dodd
- The Daffodil Centre, a joint venture between Cancer Council NSW and The University of Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, NSW, Australia.
| | - Ashleigh R Sharman
- Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Deborah McGregor
- Faculty of Science, Medicine and Health, The University of Wollongong, NSW, Australia
| | - Emily Stone
- Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Department of Thoracic Medicine, St Vincent's Hospital, Darlinghurst, NSW, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, NSW, Australia
| | - Candice Donnelly
- Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Henry Marshall
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia; The University of Queensland Thoracic Research Centre, Brisbane, QLD, Australia
| | - Nicole M Rankin
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Dlamini SB, Sartorius B, Ginindza TG. Pre- and post-intervention survey on lung cancer awareness among adults in selected communities in KwaZulu-Natal, South Africa: A quasi-experimental study. J Public Health Afr 2023; 14:2131. [PMID: 36798842 PMCID: PMC9926557 DOI: 10.4081/jphia.2023.2131] [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: 01/19/2022] [Accepted: 06/01/2022] [Indexed: 02/04/2023] Open
Abstract
Background Lung cancer remains the number one cause of cancer mortality estimated at 1.8 million deaths. There are limited studies in resource poor countries regarding knowledge, attitudes and practices towards lung cancer. Objective This study aimed to assess the effects of a lung cancer awareness intervention in selected communities in KwaZulu- Natal, South Africa. Materials and Methods A quasi-experimental study design was conducted in the selected communities in KwaZulu-Natal. A community intervention was administered in the communities after a baseline survey. The intervention effects were assessed a month after implementation. Results There were statistical differences in the mean age (p<0.001) and proportion of males and females (p<0.001) at baseline and post-intervention. There were no differences in terms of smoking status (p=0.958), however, there was a reduction in the number of cigarettes smoked per day (p<0.001) and the number of packs smoked per week (p=0.026). The mean knowledge score increased from 41.8% (95% CI 35.7 - 47.9) at baseline to 59.9 (95% CI 53.8 - 66.0) post-intervention (p<0.001). The proportion of participants who were aware that lung cancer can be detected early increased from 46.5% (95% CI 39.1 - 53.9) at baseline to 81.1% (95% CI 71.7 - 87.9) post-intervention (p<0.001). The intervention had a statistically significant effect (aOR 4.370, 95% CI 1.477-12.928) on the level of lung cancer knowledge in the selected communities (p<0.001). Conclusions Interventions increasing the recognition of signs and symptoms, focusing on the importance of early detection and health seeking behaviour (including screening), smoking cessation, and addressing the perceived health system barriers are required.
Collapse
Affiliation(s)
- Siyabonga B. Dlamini
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa,Cancer and Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa,Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, 2nd Floor George Campbell Building, Mazisi Kunene Road, 4041, Durban, South Africa, Tel. (+2731) 260 4499. Fax. (+2731) 260 4211.
| | - Benn Sartorius
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK,Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, USA
| | - Themba G. Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa,Cancer and Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
12
|
Nam J, Krishnan G, Shofer S, Navuluri N. Interventions to improve lung cancer screening among racially and ethnically minoritized groups: A scoping review. Lung Cancer 2023; 176:46-55. [PMID: 36610272 DOI: 10.1016/j.lungcan.2022.12.016] [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: 08/18/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
Lung cancer screening (LCS) decreases lung cancer related mortality among high-risk people who smoke cigarettes and has been endorsed by the US Preventive Services Task Force (USPSTF) since 2013. However, adoption of LCS has been limited, and disparities in LCS among racially and ethnically minoritized groups have become apparent. While recommendations to improve disparities in LCS have been made, there is a lack of information on how these recommendations have been implemented and their relative effectiveness in improving screening disparities. This scoping review addresses this knowledge gap by examining interventions that have been implemented to improve LCS among racially and ethnically minoritized groups in the United States. A comprehensive search of MEDLINE (via PubMed), EMBASE (via Elsevier), CINAHL Complete (via EBSCO), and Scopus (via Elsevier), for articles from the period 1 January 2010 through 22 October 2021 was completed. Out of 17,045 references screened, only 11 studies describing an intervention to improve disparities in LCS were identified, underscoring the dearth of data on established interventions. The interventions discussed could be categorized into three groups -- patient level (n = 3), clinic/institution level (n = 3), and community level (n = 5) interventions. Of those studies reporting effectiveness data (n = 8), there was substantial heterogeneity in the outcomes measured and their relative effectiveness. We found that interventions which streamlined the LCS process at the level of a single clinic or institution were the most effective in improving LCS. Community-level interventions that focused on engagement and education had the greatest potential to target racially and ethnically minoritized groups. Our study underscores the need for more robust research on addressing barriers to LCS by identifying effective patient, clinic, and community-level interventions to improve LCS disparities and the need for potential standardization of intervention effectiveness outcomes.
Collapse
Affiliation(s)
- Jason Nam
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC 27710, USA; Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - Govind Krishnan
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC 27710, USA.
| | - Scott Shofer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC 27710, USA; Durham Veterans Affairs Medical Center, Durham, NC 27710, USA
| | - Neelima Navuluri
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC 27710, USA; Durham Veterans Affairs Medical Center, Durham, NC 27710, USA; Duke Global Health Institute, Duke University, Durham, NC, USA
| |
Collapse
|
13
|
Costantini L, Del Riccio M, Piccoli E, Lavecchia V, Corradini E, Bonaccorsi G, Martucci G, Lavserack G. Use of digital technologies to support cancer screening in community health promotion interventions: scoping review. Health Promot Int 2023; 38:7033125. [PMID: 36757345 DOI: 10.1093/heapro/daac189] [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: 02/10/2023] Open
Abstract
The scoping review investigated how digital technologies have helped to increase cancer screening uptake in communities including adolescents, adults and elderly people during the COVID-19 outbreak between January 2020 and June 2021. Thirteen studies were identified as being relevant, mostly addressing underserved or minority communities with the purpose to increase screening uptake, delivering health education or investigating social and cultural barriers to cancer screening. The interventions effectively used digital technologies such as mobile apps and messengers mobile apps, messaging and Web platforms. The limitations imposed by COVID-19 on social interaction can be supported with digital solutions to ensure the continuity of cancer screening programs. However, more research is needed to clarify the exact nature of effectiveness, especially in large-scale interventions.
Collapse
Affiliation(s)
- Luigi Costantini
- School of Community Medicine and Primary Care, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Del Riccio
- School of Hygiene and Preventive Medicine, Department of Health Sciences, University of Florence, Florence, Italy
| | - Elisa Piccoli
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Vincenzo Lavecchia
- School of Community Medicine and Primary Care, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Corradini
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Gianfranco Martucci
- Regional Center for Multimedial Learning in Health Promotion, Italian League Against Tumors, Reggio Emilia, Italy
| | - Glenn Lavserack
- Department of Sociology and Social Research, University of Trento, Trento, Italy
| |
Collapse
|
14
|
Martinez MC, Stults CD, Li J. Provider and patient perspectives to improve lung cancer screening with low-dose computed tomography 5 years after Medicare coverage: a qualitative study. BMC PRIMARY CARE 2022; 23:332. [PMID: 36539693 PMCID: PMC9768892 DOI: 10.1186/s12875-022-01925-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022]
Abstract
Lung cancer remains the leading cause of cancer-related deaths for both men and women in the U.S., yet uptake of preventive cancer screening for people with a heavy smoking history remains low. This qualitative interview study of patients and providers from a large ambulatory healthcare system in northern and central California reevaluated perceptions of lung cancer screening with low-dose computed tomography (LCS-LDCT) 5 years after Medicare coverage. We hypothesized that initial attitudes and barriers within the LCS-LDCT discussion and process have likely persisted with little change since Medicare coverage and we sought to understand how these attitudes continue to impact effective implementation and uptake of screening with the goal of identifying opportunities for improvement. Between 2019 and 2020, interviews were conducted with 10 primary care physicians and 30 patients using semi-structured interview guides. Providers and patients expressed that they were both aware and supportive of LCS-LDCT, a change from earlier studies, but continued to report little to no shared decision making nor use of a decision aid despite being Medicare requirements. Creation and incorporation of a single-page, graphic heavy decision aid may help address many of the persistent barriers around implementation for both providers and patients. Given recently expanded guidelines from the U.S. Preventive Services Task Force for LCS-LDCT screening and their coverage by Medicare, it is important for healthcare systems to understand provider and patient perceptions to further improve the implementation of LCS-LDCT to ultimately reduce lung cancer mortality.
Collapse
Affiliation(s)
- Meghan C. Martinez
- grid.416759.80000 0004 0460 3124Center for Health Systems Research, Palo Alto Medical Foundation Research Institute, Sutter Health, 795 El Camino Real, Ames Building, Palo Alto, CA 94301 USA
| | - Cheryl D. Stults
- grid.416759.80000 0004 0460 3124Center for Health Systems Research, Palo Alto Medical Foundation Research Institute, Sutter Health, 795 El Camino Real, Ames Building, Palo Alto, CA 94301 USA
| | - Jiang Li
- grid.416759.80000 0004 0460 3124Center for Health Systems Research, Palo Alto Medical Foundation Research Institute, Sutter Health, 795 El Camino Real, Ames Building, Palo Alto, CA 94301 USA
| |
Collapse
|
15
|
Phetphum C, Prajongjeep A, Keeratisiroj O, Thawatchaijareonying K. Communication intervention to improve perceived threat of
smoking-related COVID-19 and intentions to quit smoking
during the COVID-19 pandemic in Thailand. Tob Induc Dis 2022; 20:66. [PMID: 35949929 PMCID: PMC9310059 DOI: 10.18332/tid/150363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Chakkraphan Phetphum
- Department of Community Health, Faculty of Public Health, Naresuan University, Phitsanulok, Thailand
| | - Atchara Prajongjeep
- Department of Community Public Health, Sirindhorn College of Public Health Phitsanulok, Phitsanulok, Thailand
| | - Orawan Keeratisiroj
- Department of Community Health, Faculty of Public Health, Naresuan University, Phitsanulok, Thailand
| | | |
Collapse
|
16
|
Bujarski S, Flowers R, Alkhunaizi M, Cuvi D, Sathya S, Melcher J, Kheradmand F, Holt G. Challenges in initiating a lung cancer screening program: Experiences from two VA medical centers. Semin Oncol 2022; 49:S0093-7754(22)00046-X. [PMID: 35853765 DOI: 10.1053/j.seminoncol.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 11/11/2022]
Abstract
Establishing a lung cancer screening (LCS) program is an important endeavor that delivers life-saving healthcare to an at-risk population. However, developing a comprehensive LCS program requires critical elements including obtaining institutional level buy-in, hiring necessary personnel, developing appropriate infrastructure and actively engaging primary care providers, subspecialty services, and radiology. The process required to connect such services to deliver an organized LCS program that reaches all eligible candidates must be individualized to each institution's needs and infrastructure. Here we provide detailed experiences from two successful LCS programs, one using a primary care provider-based service and the other using a consult-based service. In each case, we provide the pros and cons of each system. We propose that the decision to setup an ideal LCS program could include a hybrid design that combines aspects of each system.
Collapse
Affiliation(s)
- Stephen Bujarski
- Section of Pulmonary, Critical Care and Sleep Medicine, Michael E. DeBakey VA Medical Center, Houston TX, USA; Department of Medicine, Baylor College of Medicine, Houston TX, USA.
| | - Robert Flowers
- Department of Medicine, Jackson Memorial Hospital, University of Miami, Miami, FL, USA
| | | | - Dave Cuvi
- Division of Pulmonology, Department of Medicine, Miami VA Medical Center, Miami, FL, USA
| | - Sneha Sathya
- Division of Pulmonary, Allergy Critical Care and Sleep Medicine, Department of Medicine, University of Miami, Miami, FL, USA
| | - Jennifer Melcher
- Lung Precision Oncology Program, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Farrah Kheradmand
- Section of Pulmonary, Critical Care and Sleep Medicine, Michael E. DeBakey VA Medical Center, Houston TX, USA; Department of Medicine, Baylor College of Medicine, Houston TX, USA
| | - Gregory Holt
- Division of Pulmonology, Department of Medicine, Miami VA Medical Center, Miami, FL, USA; Division of Pulmonary, Allergy Critical Care and Sleep Medicine, Department of Medicine, University of Miami, Miami, FL, USA
| |
Collapse
|
17
|
Patients' Perceptions at Diagnosis: Lung Cancer Discovery and Provider Relationships. Cancer Nurs 2022; 45:397-405. [PMID: 35067577 PMCID: PMC9294071 DOI: 10.1097/ncc.0000000000001050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND In the United States, most lung cancer cases are diagnosed at advanced stages, limiting treatment options and impacting survival. This study presents patients' perspectives on the complexity of factors influencing a lung cancer diagnosis. Lung cancer awareness regarding risks, symptoms, smoking behaviors, family history, and environmental factors can lead to preventative and early detection measures. OBJECTIVE The aim of this study was to explore lung cancer patient perspectives on lung cancer awareness within the context of an earlier study to understand sleep-wake disturbances in adults with non-small cell lung cancer. METHODS A content analysis was used to analyze the original deidentified longitudinal interview data collected from 26 patients diagnosed with lung cancer. RESULTS Of the original 26 participants, 16 were included in this secondary data analysis. The participants were primarily females (n = 10) and Whites (n = 13), with ages ranging between 49 and 83 years. Half of the sample was diagnosed with stage IV lung cancer and most of the sample was on chemotherapy (n = 10). Two key themes were identified: the lung cancer discovery and the patient-physician relationship. CONCLUSIONS Unspecific initial symptoms, lack of knowledge and screening, as well as fear of the diagnosis delayed seeking medical care. Patient-physician relationships were hindered by smoking-associated stigma, inadequate sharing of information, and lack of coordinated, holistic care. Positive communication strategies are critical between patients and providers to meet patients' specific needs. IMPLICATIONS FOR PRACTICE Educational interventions that enhance lung cancer awareness may improve prevention and screening actions, improve timely healthcare intervention, and reduce incidence and mortality.
Collapse
|
18
|
Worry About the Future Health Issues of Smoking and Intention to Screen for Lung Cancer With Low-Dose Computed Tomography. Cancer Nurs 2022; 45:E146-E152. [PMID: 34870941 PMCID: PMC8649175 DOI: 10.1097/ncc.0000000000000897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Early diagnosis of lung cancer is key to improving the long-term prognosis for many individuals. Still, utilization rates of lung cancer screening (LCS) remain low. OBJECTIVE To investigate the association between worry about future health issues of smoking and intention to undergo recommended LCS with low-dose computed tomography (LDCT) within the next 3 months. METHODS A cross-sectional online survey was conducted using the Qualtrics Panel to recruit adult smokers between ages 54 and 75 years, with no history of lung cancer, and at least 30-pack-year smoking history (n = 152). The survey gathered demographic, socioeconomic, and psychographic information, including intention to screen for lung cancer with LDCT and worry about the future health issues of smoking. Data were analyzed using multivariable logistic regression. RESULTS Approximately 43.0% were White, 21.7% were Black, and 60.0% were female. Most (86.0%) reported intentions to undergo recommended LCS with LDCT in the next 3 months. More than one-third (32.0%) reported moderately/very worried about the future health issues of smoking. Smokers who were moderately/very worried had 20% (P = .022) higher odds of reporting an intention to undergo LCS with LDCT than those who were not at all or a little worried. CONCLUSIONS Most eligible adults reported intentions to undergo LCS with LDCT. Our study also highlights sex, racial, and socioeconomic differences in LCS behavior. IMPLICATIONS FOR PRACTICE The study findings provide an opportunity for healthcare providers to have in-depth discussions about the benefits of LCS with those who express worry about future health issues of smoking.
Collapse
|
19
|
Williams LB, Shelton BJ, Gomez ML, Al-Mrayat YD, Studts JL. Using Implementation Science to Disseminate a Lung Cancer Screening Education Intervention Through Community Health Workers. J Community Health 2021; 46:165-173. [PMID: 32594413 DOI: 10.1007/s10900-020-00864-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
National lung cancer screening with low dose computed tomography (LDCT) uptake is suboptimal. One factor contributing to slow uptake is lack of awareness. Trained Community Health Workers (CHWs) may be effective in increasing lung cancer screening awareness among disparate populations, however little is known about the processes necessary to scale an intervention for implementation by CHWs in a new area. We examined implementation processes with the RE-AIM framework and pilot tested a CHW-delivered lung cancer education intervention based on the Health Belief Model. We measured pre-post participant knowledge, attitudes and beliefs regarding cancer screening, lung cancer stigma, and intent to obtain LDCT screening. We used community-engaged strategies to collaborate with a local health system, to identify CHWs. CHWs were trained to recruit participants and deliver the one-session lung cancer education intervention. Seven CHWs and eight community sites participated. Participants (n = 77) were female (53%) primarily low income (62.9%); tobacco use was high (36.9%). Post intervention changes in lung cancer screening knowledge (p = < .0001), attitudes regarding lung cancer screening benefit (p = .034) and lung cancer stigma. (p = .024) We learned important lessons that will be useful in subsequent scaling. Collaborating with a local health system is a promising method to disseminate a lung cancer screening education intervention.
Collapse
Affiliation(s)
- Lovoria B Williams
- College of Nursing, University of Kentucky, 751 Rose St. 531 College of Nursing Building, Lexington, KY, 40536-0232, USA.
| | - Brent J Shelton
- College of Medicine, Cancer Biostatistics within the Division of Medical Oncology, University of Kentucky, Lexington, KY, USA
| | - Maria L Gomez
- College of Nursing, University of Kentucky, 751 Rose St. 531 College of Nursing Building, Lexington, KY, 40536-0232, USA
| | - Yazan D Al-Mrayat
- College of Nursing, University of Kentucky, 751 Rose St. 531 College of Nursing Building, Lexington, KY, 40536-0232, USA
| | - Jamie L Studts
- Department of Behavioral Science, University of Kentucky, College of Medicine, Lexington, KY, USA
| |
Collapse
|
20
|
Schiffelbein JE, Carluzzo KL, Hasson RM, Alford-Teaster JA, Imset I, Onega T. Barriers, Facilitators, and Suggested Interventions for Lung Cancer Screening Among a Rural Screening-Eligible Population. J Prim Care Community Health 2021; 11:2150132720930544. [PMID: 32506999 PMCID: PMC7278309 DOI: 10.1177/2150132720930544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction: Rural areas are disproportionally affected by lung cancer late-stage incidence and mortality. Lung cancer screening (LCS) is recommended to find lung cancer early and reduce mortality, yet uptake is low. The purpose of this study was to elucidate the barriers to, facilitators of, and suggested interventions for increasing LCS among a rural screening-eligible population using a mixed methods concurrent embedded design study. Methods: Qualitative and quantitative data were collected from rural-residing adults who met the eligibility criteria for LCS but who were not up-to-date with LCS recommendations. Study participants (n = 23) took part in 1 of 5 focus groups and completed a survey. Focus group discussions were recorded, transcribed, and coded through a mixed deductive and inductive approach. Survey data were used to enhance and clarify focus group results; these data were integrated in the design and during analysis, in accordance with the mixed methods concurrent embedded design approach. Results: Several key barriers to LCS were identified, including an overall lack of knowledge about LCS, not receiving information or recommendation from a health care provider, and lack of transportation. Key facilitators were receiving a provider recommendation and high motivation to know the screening results. Participants suggested that LCS uptake could be increased by addressing provider understanding and recommendation of LCS and conducting community outreach to promote LCS awareness and access. Conclusion: The results suggest that the rural screening-eligible population is generally receptive to LCS. Patient-level factors important to getting this population screened include knowledge, transportation, motivation to know their screening results, and receiving information or recommendation from a provider. Addressing these factors may be important to increase rural LCS uptake.
Collapse
Affiliation(s)
- Jenna E Schiffelbein
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | | | - Rian M Hasson
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.,Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jennifer A Alford-Teaster
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Inger Imset
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Tracy Onega
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| |
Collapse
|
21
|
Saab MM, FitzGerald S, Noonan B, Kilty C, Collins A, Lyng Á, Kennedy U, O'Brien M, Hegarty J. Promoting lung cancer awareness, help-seeking and early detection: a systematic review of interventions. Health Promot Int 2021; 36:1656-1671. [PMID: 33647930 PMCID: PMC8699397 DOI: 10.1093/heapro/daab016] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Lung cancer (LC) is the leading cause of cancer death. Barriers to the early presentation for LC include lack of symptom awareness, symptom misappraisal, poor relationship with doctors and lack of access to healthcare services. Addressing such barriers can help detect LC early. This systematic review describes the effect of recent interventions to improve LC awareness, help-seeking and early detection. This review was guided by the Cochrane Handbook for Systematic Reviews of Interventions. Electronic databases MEDLINE, CINAHL, ERIC, APA PsycARTICLES, APA PsycInfo and Psychology and Behavioral Sciences Collection were searched. Sixteen studies were included. Knowledge of LC was successfully promoted in most studies using educational sessions and campaigns. LC screening uptake varied with most studies successfully reducing decision conflicts using decision aids. Large campaigns, including UK-based campaign 'Be Clear on Cancer', were instrumental in enhancing LC awareness, promoting help-seeking and yielding an increase in chest X-rays and a decrease in the number of individuals diagnosed with advanced LC. Multimodal public health interventions, such as educational campaigns are best suited to raise awareness, reduce barriers to help-seeking and help detect LC early. Future interventions ought to incorporate targeted information using educational resources, face-to-face counselling and video- and web-based decision aids.
Collapse
Affiliation(s)
- Mohamad M Saab
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland T12 AK54
| | - Serena FitzGerald
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland T12 AK54
| | - Brendan Noonan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland T12 AK54
| | - Caroline Kilty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland T12 AK54
| | - Abigail Collins
- National Cancer Control Programme, Health Service Executive, Ireland DO1 A3Y8
| | - Áine Lyng
- National Cancer Control Programme, Health Service Executive, Ireland DO1 A3Y8
| | - Una Kennedy
- National Cancer Control Programme, Health Service Executive, Ireland DO1 A3Y8
| | - Maidy O'Brien
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland T12 AK54
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland T12 AK54
| |
Collapse
|
22
|
Li C, Liu Y, Xue D, Chan CWH. Effects of nurse-led interventions on early detection of cancer: A systematic review and meta-analysis. Int J Nurs Stud 2020; 110:103684. [PMID: 32702568 DOI: 10.1016/j.ijnurstu.2020.103684] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/28/2020] [Accepted: 06/06/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Early detection of cancer serves an important strategy for cancer control, but its uptake rate remains relatively limited. Nurse-led interventions may have potential benefits for the early detection of cancer, but the evidence remains unclear. OBJECTIVES Synthesise the evidence on the impact of nurse-led interventions on early cancer detection. The primary outcome was early cancer detection uptake rate. Secondary outcomes were cancer knowledge, early detection beliefs, diagnosed precancerous lesions and early-stage cancers. DESIGN A systematic review and meta-analysis of randomised controlled trails. DATA SOURCES Eight English language databases (British Nursing Index, Cochrane Central Register of Controlled Trials, CINAHL Complete, EMBASE, Ovid Emcare, Medline, Scopus, Web of Science Core Collection) and three Chinese language databases (Chinese Biomedical Literature Databases, China Journal Net, and Wanfang Data) were searched from inception date to September 2019. Grey literature and reference lists of included studies were also examined. REVIEW METHODS Two reviewers independently assessed eligibility, extracted data and evaluated methodological quality using the Cochrane risk of bias (RoB 2.0) tool. Meta-analyses and descriptive analyses were used. Subgroup analyses were conducted for study settings and intervention types. RESULTS Ten studies examined the effects of nurse-led interventions, including education, patient reminders, counselling, and patient navigation, on early detection of breast or cervical cancer, colorectal cancer, and lung cancer. Nurse-led interventions improved the uptake rates of mammography [risk ratio (RR) = 1.97; 95% confidence interval (CI): 1.17-3.33; p = 0.01], clinical breast examination (RR = 2.16; 95% CI: 1.02-4.59; p = 0.05), regular breast self-examination (RR = 2.01; 95% CI: 1.54-2.63; p < 0.001), and colonoscopy (RR = 1.90; 95% CI: 1.57-2.30; p < 0.001), but not of faecal blood occult tests. Subgroup analyses showed significantly improved mammography and clinical breast examination uptake rates for interventions conducted at health centres, and that patient navigation had better effects on improving colonoscopy uptake rates than did counselling. The intervention also improved cancer knowledge, early detection beliefs, and cases of detected precancerous lesions. CONCLUSIONS Nurse-led interventions may improve early cancer detection uptake rates, cancer knowledge, early detection beliefs, and cases of detected precancerous lesions. The effects of nurse-led interventions conducted in home settings on improving mammography and clinical breast examination uptake rates may need further exploration. Patient navigation may be superior to counselling in improving colonoscopy uptake rates. Social media may be an option for delivering early cancer detection guidance, but needs to be further explored. Tweetable abstract: Nurse-led interventions have potential effects on promoting early detection of cancer.
Collapse
Affiliation(s)
- Caixia Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Esther Lee Building, Shatin, N.T., Hong Kong, China.
| | - Yunhong Liu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Esther Lee Building, Shatin, N.T., Hong Kong, China.
| | - Dandan Xue
- The School of Nursing, Chongqing Medical University, ChongQing, China.
| | - Carmen W H Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Esther Lee Building, Shatin, N.T., Hong Kong, China.
| |
Collapse
|