HEALTH CARE DISPARITIES IN WOMEN AND MINORITIES: APPLICABILITY OF LUNG CANCER SCREENING CRITERIA

CHEST Journal ◽  
2019 ◽  
Vol 155 (4) ◽  
pp. 196A
Author(s):  
C.F. Chang ◽  
C. Vu ◽  
S. Lin ◽  
J. Nieva
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Cancer Screening ◽  
Health Care Disparities ◽  
Lung Cancer Screening ◽  
Screening Criteria

scholarly journals Relationships Between Health Care Disparities and Coverage Policies for Breast, Colon, and Lung Cancer Screening

2019 ◽  
Vol 16 (4) ◽  
pp. 580-585 ◽  
Author(s):  
Lincoln L. Berland ◽  
Debra L. Monticciolo ◽  
Efren J. Flores ◽  
Sharp F. Malak ◽  
Judy Yee ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Cancer Screening ◽  
Health Care Disparities ◽  
Lung Cancer Screening

scholarly journals Perspectives of family physicians towards access to lung cancer screening for individuals living with low income – a qualitative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ambreen Sayani ◽  
Mandana Vahabi ◽  
Mary Ann O’Brien ◽  
Geoffrey Liu ◽  
Stephen W. Hwang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Cancer Screening ◽  
Cancer Risk ◽  
Low Income ◽  
Lung Cancer Risk ◽  
Family Physicians ◽  
Lung Cancer Screening ◽  
Preventative Care ◽  
Systems Model

Abstract Background Individuals living with low income are less likely to participate in lung cancer screening (LCS) with low-dose computed tomography. Family physicians (FPs) are typically responsible for referring eligible patients to LCS; therefore, we sought to understand their perspectives on access to lung cancer screening for individuals living with low income in order to improve equity in access to LCS. Methods A theory-informed thematic analysis was conducted using data collected from 11 semi-structured interviews with FPs recruited from three primary care sites in downtown Toronto. Data was coded using the Systems Model of Clinical Preventative Care as a framework and interpretation was guided by the synergies of oppression analytical lens. Results Four overarching themes describe FP perspectives on access to LCS for individuals living with low income: the degree of social disadvantage that influences lung cancer risk and opportunities to access care; the clinical encounter, where there is often a mismatch between the complex health needs of low income individuals and structure of health care appointments; the need for equity-oriented health care, illustrated by the neglect of structural origins of health risk and the benefits of a trauma-informed approach; and finally, the multiprong strategies that will be needed in order to improve equity in health outcomes. Conclusion An equity-oriented and interdisciplinary team based approach to care will be needed in order to improve access to LCS, and attention must be given to the upstream determinants of lung cancer in order to reduce lung cancer risk.

scholarly journals Lung cancer screening patient–provider discussion: Where do we stand and what are the associated factors?

2019 ◽  
Vol 7 ◽  
pp. 205031211985426 ◽  
Author(s):  
Hamid Chalian ◽  
Pegah Khoshpouri ◽  
Arya M Iranmanesh ◽  
Joseph G Mammarappallil ◽  
Shervin Assari
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Cancer Screening ◽  
Health Care Provider ◽  
Care Provider ◽  
Odds Ratio ◽  
Associated Factors ◽  
Insurance Coverage ◽  
Lung Cancer Screening ◽  
Usual Source

Objective: The primary objective of this study was to estimate the percentage of individuals possibly eligible for lung cancer screening that report having discussed screening with a health care provider. The secondary objective was to investigate the associated factors of having patient–provider lung cancer screening discussion. Methods: Data from the Health Information National Trends Survey 2017 were used ( n = 3217). Lung cancer screening eligibility was based on the criteria utilized by the Centers for Medicare and Medicaid Services. Gender, race, educational attainment, health insurance coverage, and usual source of health care were covariates. Current or former smokers ages 55–77 ( n = 706) were considered potentially eligible for lung cancer screening (dependent variable). Results: Only 12.24% of individuals potentially eligible for lung cancer screening report prior discussion regarding lung cancer screening with a health care provider. Being eligible for lung cancer screening based on Centers for Medicare and Medicaid Services eligibility criteria was positively associated with the odds of a patient–provider lung cancer screening discussion (odds ratio = 3.95, 95% confidence interval = 2.48–6.30). Unlike gender, race, education, or insurance coverage, a usual source of health care was positively associated with a patient–provider screening discussion (odds ratio = 2.48, 95% confidence interval = 1.31–4.70). Conclusion: Individuals potentially eligible for lung cancer screening are more likely to have screening discussions with a health care provider. Having a usual source of health care may increase the odds of such a discussion, while patients are not discriminated based on race, gender, education, and insurance coverage. However, the relatively low rate (12.24%) of reported patient–provider lung cancer screening discussion indicates that significant barriers still remain.

Implementing physician education to increase lung cancer screening compliance.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18282-e18282
Author(s):  
Coral Olazagasti ◽  
Devi Sampat ◽  
Adam Rothman ◽  
Nagashree Seetharamu ◽  
David Steiger
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
High Risk ◽  
Lung Cancer Screening ◽  
Physician Education ◽  
Smoking History ◽  
Post Intervention ◽  
Screening Criteria ◽  
Screening Guidelines ◽  
Internal Medicine Clinic

e18282 Background: Lung cancer is the leading cause of cancer-related deaths worldwide. The USPSTF recommends annual low-dose CT chest (LDCT) for lung cancer screening in adults who meet the appropriate criteria: age 55-80, current smokers or former smokers who quit within 15years, with a 30 pack-year smoking history. Even with these recommendations, screening rates in these patients remain low. We created a study to assess compliance in an outpatient Internal Medicine clinic to assess the barriers for obtaining LDCT. We hypothesized that by providing an educational program, overall compliance would increase. Methods: The study was divided in two arms: a pre-intervention arm and a post-intervention assessment. Initially, 35 physicians completed a questionnaire on their attitudes to LDCT screening and their reasons for not screening high risk patients. We created a lung cancer screening education program, which consisted of lectures provided to physicians. Following the lectures, consecutive patient visits were reviewed to assess compliance with screening. Results: In the first arm, 678 visits were reviewed. 115 patients met USPSTF criteria of whom only 26% underwent screening with LDCT. The most common reasons for not ordering LDCT scans in patients meeting criteria included: poor knowledge of criteria (22%), failure to determine if patients qualified (13%), patient refusal (8%). Following the education, 208 patients out of the 955 visits reviewed met USPSTF criteria, of which 78% underwent LDCT. Our study showed how after education, physicians were ten times more likely to screen patients for lung cancer (Odds ratio 9.98, 95% CI 5.87-16.94, p < 0.0001). Conclusions: We confirmed there was suboptimal adherence to established LDCT lung cancer screening guidelines, mainly due to unfamiliarity with the screening criteria. By providing educational lectures, compliance improved significantly. We concluded that educating physicians about lung cancer screening guidelines increased LDCT screening tenfold, and therefore benefit patients that are at high risk for developing lung cancer.

Increasing lung cancer screening rates in HIV clinics.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 189-189
Author(s):  
Shawn Jindal ◽  
Maria Serrano ◽  
Sarah Baron ◽  
Matthew Stuart ◽  
Mariam Alexander ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Screening Program ◽  
Lung Cancer Screening ◽  
Lung Cancer Mortality ◽  
Smoking History ◽  
Ct Scans ◽  
Quality Improvement Initiative ◽  
Hiv Patients ◽  
Screening Criteria

189 Background: Data at our institution shows lung cancer is more prevalent and aggressive in HIV patients. A study of lung cancer patients revealed a mean age of 55.8 years in those with HIV vs. 68.0 in those without. Additionally, 67% of HIV patients had metastasis at time of diagnosis, compared to 49% in the overall population. One study found an 18.9% reduction in lung cancer mortality among HIV patients who receive NLST-recommended screening. Despite this, data from 2018 estimated only 13% of eligible HIV patients had completed screening at our institution. We pursued a quality improvement initiative to increase lung cancer screening in our HIV clinics. Methods: Our multi-disciplinary team studied charts of the 628 HIV clinic patients seen in a four-month span to identify those who had not received lung cancer screening and potential reasons why referrals were not made. We also spoke with clinic providers to identify improvement areas. Our intervention encompassed HIV patients that met CMS screening criteria (i.e. age 55-77, 30 pack-year smoking). Our process measure was new referrals to our dedicated screening coordinator, who contacts patients to arrange for CT scans. We plotted trends in appointment referrals on a run chart. Results: Areas for improvement included EMR documentation to assess screening eligibility and an occasional lack of awareness regarding criteria. Providers also cited time constraints may limit referrals. Our team identified patients that met screening criteria and generated EMR reminders for providers to refer patients to radiology. We also held sessions with providers and nursing staff to increase awareness of our screening program. Of 628 patients, 128 (20.4%) had sufficient documented smoking history to assess for screening eligibility. 81 patients (63.3%) met our criteria. Of these patients, 58 (71.6%) had not been screened or referred for screening. Through our most recent interventions, 16 (31.3%) patients have been referred to our screening coordinator, and 7 (12.1%) have received screening CT scans. Our interventions ultimately led to an increase from 23 of 81 (28.4%) patients with completed screening to a projected 46 of 81 (56.8%). Conclusions: Providing education and EMR alerts to raise awareness regarding eligibility, we substantially increased the screening rate in our clinics. Our interventions will be broadened as we return from COVID stoppages. Future interventions include increasing smoking history documentation in the EMR to allow for automated identification of screening eligibility. PDSA and interventions are ongoing with continued follow-up of efficacy.

scholarly journals Perspectives of family physicians towards access to lung cancer screening for individuals living with low income – a qualitative study

2020 ◽  
Author(s):  
Ambreen Sayani ◽  
Mandana Vahabi ◽  
Mary Ann O’Brien ◽  
Geoffrey Liu ◽  
Stephen W. Hwang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Cancer Screening ◽  
Cancer Risk ◽  
Low Income ◽  
Lung Cancer Risk ◽  
Family Physicians ◽  
Lung Cancer Screening ◽  
Preventative Care ◽  
Systems Model

Abstract Background: Individuals living with low income are less likely to participate in lung cancer screening (LCS) with low-dose computed tomography. Family physicians (FPs) are typically responsible for referring eligible patients to LCS; therefore, we sought to understand their perspectives on access to lung cancer screening for individuals living with low income in order to improve equity in access to LCS. Methods: A theory-informed thematic analysis was conducted using data collected from 11 semi-structured interviews with FPs recruited from three primary care sites in downtown Toronto. Data was coded using the Systems Model of Clinical Preventative Care as a framework and interpretation was guided by the synergies of oppression analytical lens. Results: Four overarching themes describe FP perspectives on access to LCS for individuals living with low income: the degree of social disadvantage that influences lung cancer risk and opportunities to access care; the clinical encounter, where there is often a mismatch between the complex health needs of low income individuals and structure of health care appointments; the need for equity-oriented health care, illustrated by the neglect of structural origins of health risk and the benefits of a trauma-informed approach; and finally, the multiprong strategies that will be needed in order to improve equity in health outcomes. Conclusion: An equity-oriented and interdisciplinary team based approach to care will be needed in order to improve access to LCS, and attention must be given to the upstream determinants of lung cancer in order to reduce lung cancer risk.

scholarly journals Perspectives of family physicians towards access to lung cancer screening for individuals living with low income - a qualitative study

2021 ◽  
Author(s):  
Ambreen Sayani ◽  
Mandana Vahabi ◽  
Mary Ann O’Brien ◽  
Geoffrey Liu ◽  
Stephen W. Hwang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Cancer Screening ◽  
Cancer Risk ◽  
Low Income ◽  
Lung Cancer Risk ◽  
Family Physicians ◽  
Lung Cancer Screening ◽  
Preventative Care ◽  
Systems Model

Abstract Background: Individuals living with low income are less likely to participate in lung cancer screening (LCS) with low-dose computed tomography. Family physicians (FPs) are typically responsible for referring eligible patients to LCS; therefore, we sought to understand their perspectives on access to lung cancer screening for individuals living with low income in order to improve equity in access to LCS. Methods: A theory-informed thematic analysis was conducted using data collected from 11 semi-structured interviews with FPs recruited from three primary care sites in downtown Toronto. Data was coded using the Systems Model of Clinical Preventative Care as a framework and interpretation was guided by the synergies of oppression analytical lens. Results: Four overarching themes describe FP perspectives on access to LCS for individuals living with low income: the degree of social disadvantage that influences lung cancer risk and opportunities to access care; the clinical encounter, where there is often a mismatch between the complex health needs of low income individuals and structure of health care appointments; the need for equity-oriented health care, illustrated by the neglect of structural origins of health risk and the benefits of a trauma-informed approach; and finally, the multiprong strategies that will be needed in order to improve equity in health outcomes. Conclusion: An equity-oriented and interdisciplinary team based approach to care will be needed in order to improve access to LCS, and attention must be given to the upstream determinants of lung cancer in order to reduce lung cancer risk.

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