P1.03-059 Organized High Risk Lung Cancer Screening in Ontario, Canada: A Multi-Centre Prospective Evaluation

Abstract

Guidelines published in Ontario Canada in 2013, recommend screening individuals at high risk of lung cancer with low-dose computed tomography through an organized program. Cancer Care Ontario, Ontario’s provincial cancer agency, is implementing a prospective evaluation of organized high risk lung cancer screening (HRLCS) in a 2-year, multi-center pilot. The pilot evaluation aims to inform: Recommendations to Ontario’s Ministry of Health and Long Term Care regarding the potential for a provincial program; Optimal program design and requirements for effective implementation. The process to establish a robust evaluation plan for the HRLCS pilot included the development of a logic model, evaluation objectives and evaluation questions. Input from a multidisciplinary panel of experts, including clinicians, epidemiologists, and administrators guided the development of the evaluation plan. A modified Delphi technique facilitated panel input on the proposed evaluation questions, which were drafted based on the logic model and evaluation objectives, and aligned to the steps in the screening pathway. Panel members rated the importance of each evaluation question through an online survey using a 5-point Likert scale, and proposed changes or additional questions. A question was retained if >75% of panel members rated it as important or very important. A facilitated discussion post survey enabled a review of survey results to confirm consensus on the final set of evaluation questions. The survey was completed by all panel members. Of 32 evaluation questions proposed, 31 were rated as important or very important by more than 75% of respondents. Endorsed questions addressed both screening processes and key outcomes, and included, for example: Did recruitment strategies engage individuals representative of the eligible population? Did the follow-up processes occur as intended? Did screening identify early stage lung cancers? Panel discussion led to retention of the single question that did not meet the threshold, and the addition of one new question to the evaluation plan. Given consensus was achieved, a second round modified Delphi survey was not required. Using an expert panel and modified Delphi technique was an effective method to obtain consensus on the pilot evaluation questions. Endorsed evaluation questions will frame the development of measures and indicators to be assessed throughout the pilot. This comprehensive evaluation strategy will inform the design and implementation of a high quality organized HRLCS screening program.