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Lung Cancer Screening: A Multilevel Intervention

Institution: University of California, San Francisco
Investigator(s): Celia Kaplan, Dr.P.H.
Award Cycle: 2017 (Cycle 26) Grant #: 26IR-0006 Award: $374,770
Subject Area: Early Diagnosis of Tobacco-Related Cancer
Award Type: High Impact Research Project Award

Initial Award Abstract

Lung cancer is the leading cause of cancer death in the U.S. among both men and women. Until recently, no effective screening tool existed to detect lung cancer at an early stage. In 2010, National Lung Screening Trial found promising results for a new screening process using low-dose computed tomography (LDCT). There was a significant reduction in lung cancer mortality among individuals at high risk who received LDCT scans compared to traditional chest radiography. Based on these results and after evaluating the benefits and harms of LDCT, the United States Preventive Services Task Force, an independent panel of experts in primary care and prevention, now recommends annual lung cancer screening for high-risk patients using this new process. More recently, the Centers for Medicare and Medicaid Services added annual LDCT screening as a preventive service, stipulating that the order for screening should occur during a screening/shared decision-making visit. Considering these recommendations, patients, together with their physicians, should weigh currently known benefits of LDCT with its limitations and risks to make an informed decision about being screened. Despite this emphasis on shared decision making, it is unknown what patients understand about the screening process and its potential risks and benefits or how physicians can best promote discussions during the primary care visit. Primary care physicians (PCPs), who are key players in the discussion of lung cancer screening, may have difficulty determining patient eligibility and appropriateness of screening. Also, patients require information presented in a format that is culturally and linguistically appropriate to determine their individual risk and to evaluate LDCT screening. Currently, there are no standards for conducting these patient-physician discussions, particularly among patients with limited health literacy, limited English proficiency or from diverse cultural backgrounds. To fill this void, our study will develop and test the feasibility of the Lung Cancer Assessment of Risk and Education (LungCARE) intervention to increase discussions about lung cancer screening between patients and physicians. This bilingual (English, Spanish) intervention will be designed to reach multiethnic (Asian, black. Latino, white) patients and will be implemented at three levels of the healthcare structure: patient, physician, and system. The patient component has a decision tool that patients will use just prior to the visit with their PCPs. This tool will inform them about lung cancer and the screening process and help determine their individual risk. It will also help clarify their values and preferences about screening and medical decisions. Patients will receive immediate feedback in a report (patient report). At the physician level, PCPs will receive a similar report (physican report), which will be delivered electronically or in paper form prior to the visit. The system component consists of related information embedded in the electronic medical record system to help physicians identify eligible patients, document discussions of risk and screening, and streamline the referral process. To achieve our study goals, we will develop LungCARE and the comparison group condition. Preliminary testing of LungCARE will occur prior to full implementation via a randomized control trial (RCT) at the University of California, San Francisco, General Internal Medicine clinics. The RCT will evaluate LungCARE among 50 PCPs and 120 high-risk patients. We will determine whether intervention is accepted by patients and physicians and whether patients who received LungCARE are more likely to discuss lung cancer screening and lung cancer risk with their physicians. We expect our research to provide specific recommendations that will facilitate patient-physician discussions about LDCT screening and promote shared decision-making among ethnically diverse patients.