Implementation of a Lung Cancer Screening Program in Two Federally Qualified Health Centers

2021 ◽  
pp. 003335492097171
Author(s):  
Lesley Watson ◽  
Megan M. Cotter ◽  
Shauna Shafer ◽  
Kara Neloms ◽  
Robert A. Smith ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Screening Program ◽  
Lung Cancer Screening ◽  
Pilot Project ◽  
Health Centers ◽  
Smoking History ◽  
Federally Qualified Health Centers ◽  
Cancer Society ◽  
Improved Outcomes

Using low-dose computed tomography (LDCT) to screen for lung cancer is associated with improved outcomes among eligible current and former smokers (ie, aged 55-77, at least 30-pack–year smoking history, current smoker or former smoker who quit within the past 15 years). However, the overall uptake of LDCT is low, especially in health care settings with limited personnel and financial resources. To increase access to lung cancer screening services, the American Cancer Society partnered with 2 federally qualified health centers (FQHCs) in Tennessee and West Virginia to conduct a pilot project focused on developing and refining the LDCT screening referral processes and practices. Each FQHC was required to partner with an American College of Radiology–designated lung cancer screening center in its area to ensure high-quality patient care. The pilot project was conducted in 2 phases: 6 months of capacity building (January–June 2016) followed by 2 years of implementation (July 2016–June 2018). One site created a sustainable LDCT referral program, and the other site encountered numerous barriers and failed to overcome them. This case study highlights implementation barriers and factors associated with success and improved outcomes in LDCT screening.

Successes and Challenges of Implementing a Lung Cancer Screening Program in Federally Qualified Health Centers: A Qualitative Analysis Using the Consolidated Framework for Implementation Research

2020 ◽  
Author(s):  
Caitlin G. Allen ◽  
Megan M. Cotter ◽  
Robert A. Smith ◽  
Lesley Watson
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Screening Program ◽  
Lung Cancer Screening ◽  
Pilot Project ◽  
Health Centers ◽  
Implementation Barriers ◽  
Successful Program ◽  
Barriers To Implementation ◽  
Facilitators And Barriers

Abstract Background: The American Cancer Society (ACS) partnered with two federally qualified health centers (FQHCs) and American College of Radiology designated lung cancer screening facilities on a two-year pilot project to implement lung cancer screening. The project aimed to develop a referral program and care coordination practices to move patients through the screening continuum and identify critical facilitators and barriers to implementation. Methods: Evaluators conducted key informant interviews (N=46) with navigators, clinical staff, administrators from both sites, and ACS staff during annual site visits in 2017 and 2018 to capture data on implementation barriers and facilitators. Three evaluators conducted a thematic analysis using the Consolidated Framework for Implementation Research (CFIR) and assessed factors associated with effective implementation and improved screening outcomes.Results: One study site established a sustainable lung screening program, while the other encountered numerous implementation barriers which they failed to overcome. CFIR constructs highlighted critical barriers and factors associated with success and improved outcomes. Intervention Characteristics: Time spent with patients and disruption to normal workflows were challenges to implementation at both sites. Outer Setting: Both sites struggled with building patient trust and worked to gain trust by providing clear, consistent information about the screening process. One site was located in a state with Medicaid expansion that reimbursed screening but the other was not. Inner Setting: Engaged, supportive leaders who provided clear, consistent communication about implementation helped improve staff capacity, which was critical to building a successful program. Individual Characteristics: Knowledgeable, confident champions and intervention leaders were able to train, guide, and motivate staff throughout the intervention, whereas the absence of supportive leadership failed to produce staff champions and intervention leaders. Process: A slow, stepwise approach to implementation at one site allowed project champions to pilot-test the referral and reimbursement processes and resolve issues before scaling-up.Discussion: This pilot project provides insight into critical resources and steps for successful program implementation in underserved FQHC settings. Future efforts could build upon these findings by considering self-assessment and monitoring tools that incorporate CFIR constructs to help identify and address possible facilitators and barriers to implementation of LDCT.

scholarly journals Successes and challenges of implementing a lung cancer screening program in federally qualified health centers: a qualitative analysis using the Consolidated Framework for Implementation Research

2020 ◽  
Author(s):  
Caitlin G Allen ◽  
Megan M Cotter ◽  
Robert A Smith ◽  
Lesley Watson
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Program Implementation ◽  
Screening Program ◽  
Lung Cancer Screening ◽  
Health Centers ◽  
Federally Qualified Health Centers ◽  
Cancer Screening Program ◽  
Facilitators And Barriers ◽  
Lung Cancer Screening Program

Abstract In recent years, studies have shown that low-dose computed tomography (LDCT) is a safe and effective way to screen high-risk adults for lung cancer. Despite this, uptake remains low, especially in limited-resource settings. The American Cancer Society (ACS) partnered with two federally qualified health centers and accredited screening facilities on a 2 year pilot project to implement an LDCT screening program. Both sites attempted to develop a referral program and care coordination practices to move patients through the screening continuum and identify critical facilitators and barriers to implementation. Evaluators conducted key informant interviews (N = 46) with clinical and administrative staff, as well as regional ACS staff during annual site visits. The Consolidated Framework for Implementation Research guided our analysis of factors associated with effective implementation and improved screening outcomes. One study site established a sustainable lung screening program, while the other struggled to overcome significant implementation barriers. Increased time spent with patients, disruption to normal workflows, and Medicaid reimbursement policies presented challenges at both sites. Supportive, engaged leaders and knowledgeable champions who provided clear implementation guidance improved staff engagement and were able to train, guide, and motivate staff throughout the intervention. A slow, stepwise implementation process allowed one site’s project champions to pilot test new processes and resolve issues before scaling up. This pilot study provides critical insights into the necessary resources and steps for successful lung cancer screening program implementation in underserved settings. Future efforts can build upon these findings and identify and address possible facilitators and barriers to screening program implementation.

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 Attitudes towards Lung Cancer Screening in an Australian High-Risk Population

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Alexandra E. Flynn ◽  
Matthew J. Peters ◽  
Lucy C. Morgan
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
High Risk ◽  
Perceived Risk ◽  
Screening Test ◽  
Screening Program ◽  
Lung Cancer Screening ◽  
Smoking History ◽  
High Risk Population ◽  
Cancer Screening Test

Objectives. To determine whether persons at high risk of lung cancer would participate in lung cancer screening test if available in Australia and to elicit general attitudes towards cancer screening and factors that might affect participation in a screening program. Methods. We developed a 20-item written questionnaire, based on two published telephone interview scripts, addressing attitudes towards cancer screening, perceived risk of lung cancer, and willingness to be screened for lung cancer and to undertake surgery if lung cancer were detected. The questionnaire was given to 102 current and former smokers attending the respiratory clinic and pulmonary rehabilitation programmes. Results. We gained 90 eligible responses (M:F, 69:21). Mean [SD] age was 63 [11] and smoking history was 32 [21] pack years. 95% of subjects would participate in a lung cancer screening test, and 91% of these would consider surgery if lung cancer was detected. 44% of subjects considered that they were at risk of lung cancer. This was lower in ex-smokers than in current smokers. Conclusions. There is high willingness for lung cancer screening and surgical treatment. There is underrecognition of risk among ex-smokers. This misperception could be a barrier to a successful screening or case-finding programme in Australia.

scholarly journals Challenges Implementing Lung Cancer Screening in Federally Qualified Health Centers

2018 ◽  
Vol 54 (4) ◽  
pp. 568-575 ◽  
Author(s):  
Steven B. Zeliadt ◽  
Richard M. Hoffman ◽  
Genevieve Birkby ◽  
Jan M. Eberth ◽  
Alison T. Brenner ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Lung Cancer Screening ◽  
Health Centers ◽  
Federally Qualified Health Centers

scholarly journals Impact of reduced smoking rates on lung cancer screening programs in Japan

2020 ◽  
Vol 50 (10) ◽  
pp. 1126-1132
Author(s):  
Osamu Hemmi ◽  
Yumiko Nomura ◽  
Hiroshi Konishi ◽  
Tadao Kakizoe ◽  
Manami Inoue
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Cancer Detection ◽  
Screening Program ◽  
Clinical Stage ◽  
Lung Cancer Screening ◽  
Smoking Rate ◽  
Cancer Society ◽  
Age Cohorts ◽  
Screening Programs

Abstract Background In Japan, lung cancer screening by annual chest radiography has been performed for the past 30 years. However, changes in risk factor status may have influenced the efficiency of current organized lung cancer screening program. The purpose of this study was to clarify whether the reduced smoking rate in younger Japanese affects the efficiency and effectiveness of lung cancer screening. Methods We investigated chronological changes in epidemiological indicators, which support lung cancer screening programs offered by the Japan Cancer Society, such as gender- and age-specific numbers of participants and lung cancers detected by the screening by clinical stage, in relation to smoking rates from 1991 to 2016. Results Participant age at the time of screening and age at the time of cancer detection have both increased over time. The lung cancer detection rate (LCDR) in younger age cohorts tended to decrease from 1991 to 2016 in both genders, particularly men aged <55 years. Age-adjusted LCDR significantly decreased from 1991 to 2016 in both genders. After 2001, ~45% of overall detected cases in men and 70% in women were found in stage I. Although trends differed between men and women, smoking rate decreased from 1991 to 2016 in most age cohorts in both genders. Conclusions These results suggest that organized lung cancer screening in Japan should be limited to higher-risk populations.

Assessing information available for health professionals and potential participants on lung cancer screening program websites: a cross-sectional study (Preprint)

2021 ◽  
Author(s):  
Rachael Dodd ◽  
Chenyue Zhang ◽  
Ashleigh Rebecca Sharman ◽  
Julie Carlton ◽  
Ruijin Tang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Health Professionals ◽  
Assessment Tool ◽  
Screening Program ◽  
Lung Cancer Screening ◽  
Smoking History ◽  
Eligibility Criteria ◽  
Cancer Screening Program ◽  
Lung Cancer Screening Program

BACKGROUND Lung cancer is the number one cause of cancer death worldwide. The US Preventive Services Task Force (USPSTF) updated recommendations for lung cancer screening in 2021, adjusting the age of screening to 50 years (from 55 years), and reducing the number of pack-years total firsthand cigarette smoke exposure to 20 (down from 30). With many individuals using the internet for healthcare information, it is important to understand what information is available for individuals contemplating lung cancer screening. OBJECTIVE To assess the eligibility criteria and information available on lung cancer screening program websites for both health professionals and potential screeners. METHODS A descriptive cross-sectional analysis in March 2021 of 151 lung cancer screening program websites of academic (n=76) and community medical centers (n=75) in the United States for data related to information for health professionals and potential screeners was conducted. Presentation of eligibility criteria for potential participants and presence of information available specific to the health professionals about lung cancer screening, were the primary outcomes. Secondary outcomes included presentation of information about cost, smoking cessation, and inclusion of an online risk assessment tool, any clinical guidelines and multimedia used to present information. RESULTS Eligibility criteria is included in nearly all websites, with age range (92.1%) and smoking history (93.4%) included. Age was only consistent with the latest recommendations in 14.5% of the websites and no websites had updated smoking history. Half the websites mention screening costs as related to the type of insurance held. About one in six (15%) featured an online assessment tool to determine eligibility. A similar proportion (15%) hosted information specifically for health professionals. About a third (29%) of websites referred to smoking cessation. Almost a third of websites (30.5%) used multimedia to present information, such as short videos or podcasts. CONCLUSIONS Most US websites of lung cancer screening programs provide information about eligibility criteria, but this is not consistent and has not been updated across all websites following the latest USPSTF recommendations. Online resources require updating to present standardized information that is accessible for all.

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