Evaluating an outreach strategy to improve the uptake of shared decision-making for lung cancer screening

University Of Florida, Gainesville FL

Investigators

Abstract

Project Summary The proposed fellowship plan is a transdisciplinary research project integrating training in implementation science, pragmatic health services research, quality improvement, and medicine. This project is supervised by Drs. Ramzi Salloum (Dept. of Health Outcomes and Biomedical Informatics), Carma Bylund (Dept. of Health Outcomes and Biomedical Informatics), Lisa Carter-Bawa (The Cancer Prevention Precision Control Institute), and Ji-Hyun Lee (Dept. of Statistics) with the resources and support of the University of Florida (UF) College of Medicine, the UF Health Cancer Center, and the UF Clinical and Translational Science Institute. The proposal is designed to equip the trainee with the skills necessary to become a physician-scientist who bridges the divide between health systems science and clinical medicine. In addition to MD/PhD-specific professional development and expanded clinical/translational training, much of this preparation will come from technical education gained from the execution of this proposal’s research aims. Lung cancer is the leading cause of cancer-related deaths in the United States. Despite this, rates of screening have remained persistently low nationwide hovering around 6%. Rates in Florida are even lower with only 3% of eligible individuals screened in 2022, and rural areas consistently face lower rates of screening and higher rates of lung cancer mortality. The vast majority of those eligible are willing to get screened if advised to do so by their provider. However, counseling on lung cancer screening would ideally include patients actively through shared decision-making (SDM) and use of a decision aid, as required for Medicare reimbursement of lung cancer screening. Currently, providers are not consistently able to integrate either decision aids or SDM for lung cancer screening into their visits due to barriers including competing priorities during the visit, lack of provider awareness of eligibility for screening, and limited patient knowledge on lung cancer screening. This proposal will focus on evaluation of a UF Cancer Center initiative to integrate a pre-visit decision aid and outreach contact into both an urban and a rural primary care clinic workflow. Additionally, given the dedicated personnel time necessary for this strategy, this proposal also includes an economic evaluation component to facilitate future adoption. The overarching hypothesis is that a pre-visit decision aid and outreach contact will increase uptake of SDM for lung cancer screening to the extent that downstream revenue from screening, diagnostic testing, and treatment of lung cancer will offset the increased personnel costs of implementation and outreach. This will be tested via three aims: 1) assessing the feasibility of this strategy 2) evaluating its budget impact 3) identifying the determinants for successful implementation. Successful completion of this project will enhance the understanding of the barriers and facilitators to SDM in primary care more generally as well as the costs and benefits of a pre-visit decision aid and outreach contact.