Digital Health Implementation Strategies to Improve Lung Cancer Screening Among Safety-Net Clinics

Utah State Higher Education System--University Of Utah, Salt Lake City UT

Investigators

Abstract

ABSTRACT Lung cancer is the leading cause of cancer-related mortality in the U.S., accounting for approximately 1 in 5 cancer-related deaths. Approximately 80% of lung cancers are attributable to cigarette smoking. Annual Low- Dose Computed Tomography screening for lung cancer (hereafter referred to as Lung Cancer Screening or LCS) is recommended by the U.S. Preventive Services Task Force (USPSTF). Despite evidence of effectiveness and the USPSTF recommendations, implementation of LCS into clinical practice has been exceedingly limited, with only 6.5% of eligible individuals screened in 2020, and there are major health inequities in LCS related to race/ethnicity and socioeconomic status. The long-term goal of this program of research is to increase the reach of LCS among low resource healthcare settings and populations that have been historically marginalized. The proposed project, LUNG-IS, is a mixed-methods, pre-post quasi-experimental design conducted in three Utah safety-net healthcare system “Free Clinics.” LUNG-IS will establish partnerships with one free clinic per year for first 3 years of the project, and in the first year will collaborate with a nonprofit, no-cost, Free Clinic that provides high-quality, multi-disciplinary healthcare to 3,018 uinsured patients annually, 97% of whom are ≤200% of the Federal Poverty Level (FPL), 65% are ≤100%, 88% are Latino. LUNG-IS leverages existing pathways to care and Centralized Hub infrastructure that enables eligibility assessment, LCS shared decision making (SDM) with clinical decision support, screening referral, and screening logistics assistance to help overcome numerous social determinants of health that impact low resource settings and historically marginalized populations. The Centralized Hub model uses ubiquitous technologies (i.e., text messaging/telehealth) to enable safety-net patients to be assessed for LCS eligibility, engage in SDM if eligible, and be referred for LCS. For patients who decide to complete LCS, they will be provided patient navigation via Community Health Workers designed to address logistical barriers, hesitancy, and financial constraints around completing LCS. The specific aims are to 1) evaluate the impact of implementation strategies on LCS eligibility screening, SDM completion, and LCS completion, 2) characterize multi-level factors that influence implementation and effectiveness outcomes, and 3) identify and classify adaptations to implementation strategies that occur throughout the study.