MA20.07 Lung Cancer Screening for Limited-Resource Patients: Preliminary Findings from a Low-dose CT Pilot Program

Abstract

Low-dose CT (LDCT) screening for lung cancer in adults at high-risk is associated with a reduction in lung cancer mortality in high-risk adults, yet screening rates remain low. Increasing access to high-quality lung cancer screening is critical to further reducing deaths from the disease. In 2015 the American Cancer Society implemented a pilot program to identify successful strategies for improving access to LDCT in Memphis, Tennessee and Charleston, West Virginia through partnerships with Federally Qualified Health Centers (FQHCs) that serve limited resource patients. The program focused on developing systems within FQHCs to identify and refer patients for LDCT, and helping FQHCs build relationships with local accredited screening facilities to deliver lung cancer screening and navigate patients through the screening process and any necessary follow-up. This program is novel because it brings emerging technology in lung cancer screening and early detection to low-resource FQHCs that typically do not have access to state-of-the-art interventions. As such, the pilot affords important opportunities to identify facilitators and barriers to conducting LDCT in under-resourced areas. This presentation focuses on evaluation results for the program to-date, emphasizing barriers to implementation experienced by FQHCs and their screening partners. Participating FQHCs submitted quarterly monitoring reports tracking the number of: patients assessed for LDCT eligibility, shared decision-making (SDM) visits, patients screened, and screening results. Evaluators conducted site visits and stakeholder interviews with staff from FQHCs and their screening partners in summer 2017 and 2018 to capture nuanced information about program implementation. Participating FQHCs conducted 387 SDM discussions and have screened 252 patients to date. Participants expressed uncertainty about the definition and process of SDM, and difficulty with tracking and billing for these patient-provider encounters. During the project period, both sites established processes for follow-up screening and referrals based on initial screening results (LRADs 1-4). Interview data provided insight into the major challenges and successes to piloting and implementing a new protocol. Both sites struggled to agree on the correct follow-up for LRADS 3 and 4 patients. Through piloting and discussion with clinic leadership, one site successfully implemented clear, logical follow-up procedures based on staff capacity and clinical guidelines. Our evaluation findings, including key lessons learned and recommendations, add to the growing knowledge base of effective lung cancer screening practices and may be used to inform and guide health systems looking to initiate similar programs, particularly those in low-resource settings.