scholarly journals Toward Equity-oriented Cancer Care: a Strategy for Patient-oriented Research (SPOR) Protocol to Promote Equitable Access to Lung Cancer Screening.

2021 ◽  
Author(s):  
Ambreen Sayani ◽  
Jackie Manthorne ◽  
Erika Nicholson ◽  
Gary Bloch ◽  
Janet A Parsons ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Cancer Risk ◽  
Lung Cancer Risk ◽  
Lung Cancer Screening ◽  
Smoking History ◽  
Equitable Access ◽  
Learning Module ◽  
Wide Range ◽  
Oriented Research

Abstract Background: Screening for lung cancer with low dose CT can facilitate the detection of early-stage lung cancers that are amenable to treatment, reducing mortality related to lung cancer. Individuals are considered eligible for lung cancer screening if they meet specific high-risk criteria, such as age and smoking history. Population groups that are at highest risk of lung cancer, and therefore the target of lung cancer screening interventions, are also the least likely to participate in lung cancer screening, thus resulting in a widening of health inequities. Deliberate effort is needed to both reduce lung cancer risk (through upstream interventions that promote smoking cessation) as well as midstream interventions that promote equitable access to lung cancer screening. Methods: This protocol paper describes an equity-informed patient-oriented research study. Our study aims to promote equitable access to lung cancer screening by partnering with patients to co-design an e-learning module for healthcare providers. The learning module will describe the social context of lung cancer risk and promote access to lung cancer screening by increasing equity at the point of care. We have applied the Generative Co-Design Framework for Healthcare Innovation and detail our study processes in three phases and six steps: Pre-design (establishing a study governance structure); co-design (identifying research priorities, gathering and interpreting data, co-developing module content); and post-design (pilot testing the module and developing an implementation plan). Discussion: Patient engagement in research can promote the design and delivery of healthcare services that are accessible and acceptable to patients. This is particularly important for lung cancer screening as those at highest risk of developing lung cancer are also those who are least likely to participate in lung cancer screening. By detailing the steps of our participatory co-design journey, we are making visible the processes of our work so that they can be linked to future outcomes and related impact, and inform a wide range of patient co-led processes.

scholarly journals Disparities of National Lung Cancer Screening Guidelines in the US Population

2020 ◽  
Vol 112 (11) ◽  
pp. 1136-1142 ◽  
Author(s):  
Summer S Han ◽  
Eric Chow ◽  
Kevin ten Haaf ◽  
Iakovos Toumazis ◽  
Pianpian Cao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Cancer Screening ◽  
Cancer Risk ◽  
Prediction Models ◽  
Lung Cancer Risk ◽  
Task Force ◽  
Lung Cancer Screening ◽  
Smoking History ◽  
Screening Guidelines

Abstract Background Current US Preventive Services Task Force (USPSTF) lung cancer screening guidelines are based on smoking history and age (55–80 years). These guidelines may miss those at higher risk, even at lower exposures of smoking or younger ages, because of other risk factors such as race, family history, or comorbidity. In this study, we characterized the demographic and clinical profiles of those selected by risk-based screening criteria but were missed by USPSTF guidelines in younger (50–54 years) and older (71–80 years) age groups. Methods We used data from the National Health Interview Survey, the CISNET Smoking History Generator, and results of logistic prediction models to simulate lifetime lung cancer risk-factor data for 100 000 individuals in the 1950–1960 birth cohorts. We calculated age-specific 6-year lung cancer risk for each individual from ages 50 to 90 years using the PLCOm2012 model and evaluated age-specific screening eligibility by USPSTF guidelines and by risk-based criteria (varying thresholds between 1.3% and 2.5%). Results In the 1950 birth cohort, 5.4% would have been ineligible for screening by USPSTF criteria in their younger ages but eligible based on risk-based criteria. Similarly, 10.4% of the cohort would be ineligible for screening by USPSTF in older ages. Notably, high proportions of blacks were ineligible for screening by USPSTF criteria at younger (15.6%) and older (14.2%) ages, which were statistically significantly greater than those of whites (4.8% and 10.8%, respectively; P < .001). Similar results were observed with other risk thresholds and for the 1960 cohort. Conclusions Further consideration is needed to incorporate comprehensive risk factors, including race and ethnicity, into lung cancer screening to reduce potential racial disparities.

scholarly journals What is the effect of a decision aid on knowledge, values and preferences for lung cancer screening? An online pre–post study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e045160
Author(s):  
Stephen D Clark ◽  
Daniel S Reuland ◽  
Alison T Brenner ◽  
Michael P Pignone
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Cancer Risk ◽  
Decision Aid ◽  
Lung Cancer Risk ◽  
Lung Cancer Screening ◽  
False Positives ◽  
Substantial Proportion ◽  
College Degree ◽  
Out Of Pocket Costs

ObjectiveTo examine if a decision aid improves knowledge of lung cancer screening benefits and harms and which benefits and harms are most valued.DesignPre–post study.SettingOnline.Participants219 current or former (quit within the previous 15 years) smokers ages 55–80 with at least 30 pack-years of smoking.InterventionLung cancer screening video decision aid.Main measuresScreening knowledge tested by 10 pre–post questions and value of benefits and harms (reducing chance of death from lung cancer, risk of being diagnosed, false positives, biopsies, complications of biopsies and out-of-pocket costs) assessed through rating (1–5 scale) and ranking (top three ranked).ResultsMean age was 64.7±6.1, 42.5% were male, 75.4% white, 48.4% married, 28.9% with less than a college degree and 67.6% with income <US$50 000. Knowledge improved postdecision aid (pre 2.8±1.8 vs post 5.8±2.3, diff +3.0, 95% CI 2.7 to 3.3; p<0.001). For values, reducing the chance of death from lung cancer was rated and ranked highest overall (rating 4.3±1.0; 59.4% ranked first). Among harms, avoiding complications (3.7±1.3) and out-of-pocket costs (3.7±1.2) rated highest. Thirty-four per cent ranked one of four harms highest: avoiding costs 13.2%, false positives 7.3%, biopsies 7.3%, complications 5.9%. Screening intent was balanced (1–4 scale; 1-not likely 21.0%, 4-very likely 26.9%). Those ‘not likely’ to screen had greater improvement in pre–post knowledge scores and more frequently ranked a harm first than those ‘very likely’ to screen (pre–post diff:+3.5 vs +2.6, diff +0.9; 95% CI 0.1 to 1.8; p=0.023; one of four harms ranked first: 28.4% vs 11.3%, p<0.001).ConclusionsOur decision aid increased lung cancer screening knowledge among a diverse sample of screen-eligible respondents. Although a majority valued ‘reducing the chance of death from lung cancer’ highest, a substantial proportion identified harms as most important. Knowledge improvement and ranking harms highest were associated with lower intention to screen.

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.

Predictive Accuracy of the PanCan Lung Cancer Risk Prediction Model -External Validation based on CT from the Danish Lung Cancer Screening Trial

2015 ◽  
Vol 25 (10) ◽  
pp. 3093-3099 ◽  
Author(s):  
Mathilde M. Winkler Wille ◽  
Sarah J. van Riel ◽  
Zaigham Saghir ◽  
Asger Dirksen ◽  
Jesper Holst Pedersen ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Cancer Risk ◽  
Prediction Model ◽  
Lung Cancer Risk ◽  
Predictive Accuracy ◽  
External Validation ◽  
Lung Cancer Screening ◽  
Cancer Screening Trial ◽  
Screening Trial

scholarly journals Individual 5-Year Lung Cancer Risk Prediction Model in Korea Using a Nationwide Representative Database

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3496
Author(s):  
Yohwan Yeo ◽  
Dong Wook Shin ◽  
Kyungdo Han ◽  
Sang Hyun Park ◽  
Keun-Hye Jeon ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Cancer Risk ◽  
Prediction Model ◽  
Risk Prediction ◽  
Lung Cancer Risk ◽  
Lung Cancer Screening ◽  
Risk Prediction Model ◽  
C Statistic ◽  
The Mean

Early detection of lung cancer by screening has contributed to reduce lung cancer mortality. Identifying high risk subjects for lung cancer is necessary to maximize the benefits and minimize the harms followed by lung cancer screening. In the present study, individual lung cancer risk in Korea was presented using a risk prediction model. Participants who completed health examinations in 2009 based on the Korean National Health Insurance (KNHI) database (DB) were eligible for the present study. Risk scores were assigned based on the adjusted hazard ratio (HR), and the standardized points for each risk factor were calculated to be proportional to the b coefficients. Model discrimination was assessed using the concordance statistic (c-statistic), and calibration ability assessed by plotting the mean predicted probability against the mean observed probability of lung cancer. Among candidate predictors, age, sex, smoking intensity, body mass index (BMI), presence of chronic obstructive pulmonary disease (COPD), pulmonary tuberculosis (TB), and type 2 diabetes mellitus (DM) were finally included. Our risk prediction model showed good discrimination (c-statistic, 0.810; 95% CI: 0.801–0.819). The relationship between model-predicted and actual lung cancer development correlated well in the calibration plot. When using easily accessible and modifiable risk factors, this model can help individuals make decisions regarding lung cancer screening or lifestyle modification, including smoking cessation.

scholarly journals Association of Race With Lung Cancer Risk Among Adults Undergoing Lung Cancer Screening

2021 ◽  
Vol 4 (4) ◽  
pp. e214509
Author(s):  
Christine S. Shusted ◽  
Nathaniel R. Evans ◽  
Hee-Soon Juon ◽  
Gregory C. Kane ◽  
Julie A. Barta
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Cancer Risk ◽  
Lung Cancer Risk ◽  
Lung Cancer Screening

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.

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