FACTORS INFLUENCING VETERAN ADHERENCE TO LUNG CANCER SCREENING

Abstract

SESSION TITLE: Lung Cancer Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Lung cancer screening (LCS) with low-dose computed tomography has been shown in two large randomized trials to reduce mortality from lung cancer, the deadliest cancer killer, in those at high risk through early detection. More than half of incident lung cancers detected in the National Lung Screening Trial (NLST) were identified after the first year of screening. Thus, adherence to screening is a crucial aspect of an effective screening program which is often overlooked. Adherence in the VHA LCS demonstration project was higher than that of community based programs with rates of 82% at year one and 65% at year two, but still lower than that recorded in the NLST. Because mortality benefit is diminished as adherence to lung cancer screening declines, we sought to characterize factors influencing adherence to LCS. METHODS: In this qualitative study, we conducted Veteran focus groups and individual interviews of LCS coordinators. To understand the Veteran perspective, we conducted 6 focus groups of a total of 21 Veterans who had undergone at least one LCS examination. To obtain provider level feedback, we conducted telephone interviews with 8 LCS navigators at VA sites that included participants in the Lung Cancer Screening Demonstration Project and others that started screening after the demonstration project. Interviews and focus groups were recorded and transcribed verbatim, removing any identifiers. These transcriptions were formatted for entry into NVivo and coded by two separate investigators using block coding to identify underlying themes influencing adherence. RESULTS: Veterans that were adherent noted that they had specifically been told that screening was a recurrent test and that it was important to return. The theme that emerged was that clear communication and emphasis on LCS as a recurrent event was needed for Veterans. In addition, many suggested the use of other modalities, including text messaging and Veteran mobile applications to notify Veterans as the time for annual screening draws near. LCS coordinators admitted they did not emphasize adherence, had no plans for tracking it, and did not know their sites adherence rate. Each site approached bringing patients back for annual screening differently. Some only sending letters, others calling Veterans, and still others reliant on primary care providers to identify those due for annual screening. CONCLUSIONS: Adherence to LCS is crucial to optimizing outcomes in those at high risk for developing lung cancer. This study has identified system, provider and patient level factors for potential intervention to improve adherence. Future research is needed to test the impact of a multilevel intervention on adherence to LCS. CLINICAL IMPLICATIONS: Our findings identified system, provider, and patient level factors impacting LCS adherence. Improved communication, adherence tracking, and system standardization are keys to improving adherence in LCS. DISCLOSURES: No relevant relationships by Jonathan Angotti, source=Web Response No relevant relationships by Charlene Pope, source=Web Response no disclosure submitted for Nichole Tanner; no disclosure submitted for Nichole Tanner; no disclosure submitted for Nichole Tanner; no disclosure submitted for Nichole Tanner; no disclosure submitted for Nichole Tanner; no disclosure submitted for Nichole Tanner; no disclosure submitted for Nichole Tanner; no disclosure submitted for Nichole Tanner; no disclosure submitted for Nichole Tanner; no disclosure submitted for Nichole Tanner; no disclosure submitted for Nichole Tanner