Uptake Of Lung Cancer Screening Research Articles

Barriers and Facilitators Impacting Lung Cancer Screening Uptake Among Black Veterans: A Qualitative Study.

Racial disparities in lung cancer screening (LCS) are well established. Black Veterans are among those at the highest risk for developing lung cancer but are less likely to complete LCS. We sought to identify barriers and facilitators to LCS uptake among Black Veterans. A qualitative study using semistructured interviews was conducted with 32 Black Veterans to assess for barriers, facilitators, and contextual factors for LCS and strategies to improve screening. Veterans were purposively sampled by age, sex, and LCS participation status (ie, patients who received a low-dose CT [LDCT], patients who contacted the screening program but did not receive an LDCT, and patients who did not connect with the screening program nor receive an LDCT). Interview guides were developed using the Theoretical Domains Framework and Health Belief Model. Data were analyzed using rapid qualitative analysis. Barriers of LCS uptake among Black Veterans include self-reported low LCS knowledge and poor memory, attention, and decision processes associated with the centralized LCS process. Facilitators of LCS uptake among Black Veterans include social/professional role; identity and social influences; perceived susceptibility, threat, and consequences due to smoking status and military or occupational exposures; emotion, behavioral regulation, and intentions; and high trust in providers. Environmental context and resources (eg, transportation) and race and racism serve as contextual factors that did not emerge as having a major impact on LCS uptake. Strategies to improve LCS uptake included increased social messaging surrounding LCS, various forms of information dissemination, LCS reminders, balanced and repeated shared decision-making discussions, and streamlined referrals. We identified addressable barriers and facilitators for LCS uptake among Black Veterans that can help focus efforts to improve disparities in screening. Future studies should explore provider perspectives and test interventions to improve equity in LCS.

169 Can reminders improve lung cancer screening uptake amongst higher-risk populations?

169 Can reminders improve lung cancer screening uptake amongst higher-risk populations?

165 Can Pathway Navigation increase lung cancer screening uptake? Protocol for a nested randomised controlled trial and process evaluation

165 Can Pathway Navigation increase lung cancer screening uptake? Protocol for a nested randomised controlled trial and process evaluation

Abstract 4791: Characterizing interventions to reduce disparities in lung-cancer screening uptake by state Medicaid expansion status: A scoping review

Abstract Background: Lung cancer is the leading cause of cancer-related deaths in the United States, and yet, lung cancer screening rates remain persistently low. Many interventions are being developed to address the low rates of lung cancer screening (LCS), including interventions that address the additional barriers faced by historically marginalized racial and ethnic populations as well as low-income and rural populations. However, the impact of Medicaid expansion on the types of interventions developed in non-expansion states and the efficacy of those interventions is not well understood. Methods: A research librarian conducted searches in MEDLINE via PubMed, Web of Science, and Embase. Results were screened and evaluated for eligibility by three reviewers in Covidence. Data was extracted from included studies after full-text review and analyzed using both a thematic analysis and a descriptive numerical summary of studies. The chosen framework was based on scoping review guidelines by Levac et al. and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Results: Of 4696 studies found through the initial search, 53 met inclusion criteria. This includes 34 studies in Medicaid expansion states (M) and 17 studies in non-Medicaid expansion states (NM). Two additional studies compared interventions implemented in a Medicaid expansion state to a similar intervention implemented in a non-expansion state. Studies in both groups were primarily focused on addressing disparities by race and ethnicity (M=74%; NM=65%), with fewer studies focusing on rurality (M=9%; NM=12%), income (M=9%; NM=0%), or multiple disparities (M=9%; NM=24%). In non-expansion states, the most common interventions were patient navigation (29%) and community outreach (24%). While in Medicaid expansion states, the most common interventions were EHR algorithms (24%) and decision aids (21%). The intervention setting for both Medicaid expansion and non-expansion states were most commonly in a hospital/health system (M=53%; NM=47%) or community setting (M=24%; NM=47%). Interventions in both groups typically showed some improvement in uptake of LCS, though the degree of impact was variable between studies. Conclusion: Due to continued barriers to access posed by inadequate insurance coverage, there is a critical need for interventions to reduce disparities in lung cancer mortality in states that have not expanded Medicaid. Interventions focused on patient navigation and community outreach have been effective in multiple settings in these states and could fill that gap. Citation Format: Miranda J. Reid, Caretia Washington, Meghann Wheeler, Lauren Adkins, Dejana Braithwaite, Ramzi Salloum. Characterizing interventions to reduce disparities in lung-cancer screening uptake by state Medicaid expansion status: A scoping review [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4791.

Increasing Uptake of Lung Cancer Screening Among ED Patients: A Pilot Study

Increasing Uptake of Lung Cancer Screening Among ED Patients: A Pilot Study

Pilot intervention to increase uptake of lung cancer screening through the emergency department

IntroductionThe goal of this study is to demonstrate the feasibility of referring patients for lung cancer screening (LCS) from the emergency department (ED) as a method to increase the uptake of LCS. MethodsThis is a single-arm pilot study at a large safety-net ED. ED LCS-eligible patients were offered a referral to our LCS clinic upon ED discharge. The primary outcome was the frequency at which patients connected with the LCS clinic. ResultsDuring the study period, 105 patients were approached; 26 (24.8%) participated. Reasons for non-enrollment include 29 (27.6%) who were not interested in research, 10 (9.5%) who did not speak English, and 40 (38.1%) who did not meet the pack-years criteria. Seventeen patients (65.4%, 17/26) connected with the LCS clinic, with 10 (38.5%) having been seen in the clinic and received a low dose computed tomography (LDCT) scan. Of the 17 that were connected with the clinic, 7 (26.9%) had a non-LDCT chest CT scan in the past year. Of those that were not seen in the clinic (n = 9), 4 (44.4%) were unreachable via 3 phone calls and a post-marked letter, and 3 (33.3%) did not attend the scheduled appointment, and 2 (22.2%) were delayed due to COVID-19. Of those that had CT scans over the study period (n = 17), 0 scans were normal, one patient (5.9%) had asymptomatic lung cancer, 7 (41.2%) had pulmonary nodules, 11 (64.7%) had emphysema, and 9 (52.9%) had coronary artery disease. ConclusionThis pilot study suggests the feasibility and suggests initial indications of the efficacy of referring ED patients for LCS.

Abstract C113: Geographic variation in low-dose computed tomography scanning for lung cancer screening in the United States

Abstract Background: Early detection using low-dose computed tomography scanning reduces lung cancer specific mortality by 20%. Despite its efficacy and its recommendation by the United States Preventive Services Task Force, the uptake of lung cancer screening (LCS) among high-risk individuals (aged 55–80 years with a >30-pack-year smoking history and who currently smoke or have quit within the previous 15 years) remains low. The purpose of this study was to assess whether LCS uptake varies by geographic location. Methods: Data for this study were obtained from the 2019 Behavioral Risk Factor Surveillance System. After excluding ineligible subjects, 10,242 subjects were included in the final analysis. Multivariable logistic regression models were used to model the associations between the predictor and the outcome variable, adjusting for potential confounders. Results: In metropolitan statistical areas, individuals who reside outside the center city are less likely to receive LCS than those who reside in the center city (OR: 0.65; 95% CI: 0.43 – 0.98). Stratifying the data by race/ethnicity, we found a non-significant difference between Whites who reside in the center city and those outside the center city in LCS uptake (OR: 0.69; 95% CI: 0.45 – 1.06). Among Blacks (OR:0.10; 95% CI: 0.02 – 0.59) and other minorities (OR:0.10; 95% CI: 0.02 – 0.63), individuals who reside outside the center city are less likely to receive LCS than their respective counterparts residing in the center city. Nevertheless, we found a non-significant difference in LCS uptake between urban and rural counties (OR: 1.06; 95% CI: 0.76-1.48).Conclusions: LCS uptake is related to metropolitan statistical area (residents in the center city vs. outside the center city), but it is modified by race/ethnicity. This finding has important implications for policy makers and program planners in helping them design more effective interventions to promote LCS targeting racial/ethnic minorities residing outside the center city. Citation Format: Abdi T. Gudina, Lee A. Kehoe, Sara Hardy, Charles S. Kamen, Paula Cupertino. Geographic variation in low-dose computed tomography scanning for lung cancer screening in the United States [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C113.

General practice focussed strategies to increase participation in lung cancer screening – a systematic review protocol

Background Lung cancer is the leading cause of cancer-related mortality worldwide. Despite this, the uptake of lung cancer screening (LCS) using low-dose CT is substantially low in comparison to established cancer screening programmes. Additionally, those at higher risk of the disease are the least likely to participate in screening, including current smokers and those experiencing socioeconomic deprivation. General practice (which may be referred to as primary care or family medicine depending on location) plays a vital role in screening through the identification of eligible individuals, overcoming participation barriers, and facilitating shared decision-making. Given the low rates of participation, it is important to understand which, if any, strategies from general practice could improve the effectiveness of a national programme. Objectives To assess and quantify the effects of strategies implemented in general practice to increase participation in LCS. Method A systematic review and meta-analysis, where possible, will be conducted following PRISMA reporting guidelines. Searches of PubMed, Embase, CINAHL, Cochrane Library, Web of Science, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform will be conducted. All randomised trials, non-randomised studies, and quantitative descriptive studies that report recruitment strategies based in general practice and LCS outcomes will be eligible. Screening and data extraction will be conducted independently by two reviewers. The risk of bias and overall certainty of findings will be assessed using the MMAT and GRADE tools, respectively. The Template for Intervention Description and Replication (TIDieR) checklist will be used for data extraction and the Behavioural Change Techniques (BCT) Taxonomy for data analysis of the components of interventions. Conclusion This review will provide data on the most effective general practice-based recruitment strategies aimed at improving LCS participation. Understanding the most effective and equitable strategies is important in the development of successful LCS and ensuring individuals at the greatest risk can participate.

Primary care outreach and decision counseling for lung cancer screening.

Lung cancer screening rates are very low despite a level B recommendation from the United States Preventive Services Task Force since 2013 and clear evidence that lung cancer screening reduces mortality. The Center for Medicare and Medicaid Services requires shared decision-making (SDM) for lung cancer screening reimbursement. The objective of this study was to determine the effect of an SDM intervention on lung cancer screening in primary care. The study design was a single-arm clinical trial design. The intervention included phone contact outside of a primary care visit and the use of the Decision Counseling Program ®, an online interactive decision aid focused on determining the factors which influence patients to screen or not screen, prioritizing those factors, and determining a decision preference score. The primary outcome was the completion of low-dose computed tomography scan (LDCT) 1 year after the SDM session compared in participants versus nonparticipants. From six practices, there were 1359 potentially eligible patients in electronic medical record data, and 336 were reached to assess eligibility criteria. A total of 80 patients consented to be in the study, 64 completed a decision counseling session and 16 did not complete a session. Among the 64 people who agreed to have decision counseling, 45% had LDCT, higher than typically seen in routine clinical practice. Although not a comparable group, among the 16 people who declined decision counseling, none had LDCT. Decision counseling is a promising intervention that might support SDM in the context of improving uptake of lung cancer screening in primary care. However, further, larger studies are needed.

Willingness for Lung Cancer Screening: Disparities Among Informed, Screening-Eligible Individuals

BackgroundLung cancer is the leading cause of cancer-related death. Although lung cancer screening has been shown to reduce mortality, only a small fraction of eligible people receive screening. This study briefly educated screening-eligible individuals about lung cancer risk, prevention, and screening recommendations. We then evaluated race and gender as predictors of willingness to be screened once participants were educated. MethodsAn online lung cancer screening learning module was created and distributed to convenience samples of screening-eligible White Americans (n = 173) and Black Americans (n = 52) between November 2022 and February 2023. Participants viewed short modules about lung cancer risks and screening. Thereafter, participants rated their willingness to consider future screening using theory of planned behavior measurement frameworks (attitudes, norms, perceived control, and intentions to screen), with higher scores indicating greater willingness. Participant demographics were recorded. ResultsBlack Americans reported higher perceived control over obtaining screening than White Americans (t223 = −3.10; P < .001; d = 1.28). We observed no other racial differences in willingness as Black Americans and White Americans reported similar attitudes, normative beliefs, and intentions. Women also showed more positive attitudes and greater intention to be screened than men did (t223 = −2.42; P = .02; d = 1.66). ConclusionsOnce informed about lung cancer risks, prevention, and screening recommendations, Black Americans may be as willing as White Americans to undergo screening, highlighting potential causal factors other than willingness for existing racial disparities in lung cancer screening uptake. Gender differences in willingness highlight a potential need for gender-targeted outreach and communication.

Access to Lung Cancer Screening Among American Indian and Alaska Native Adults: A Qualitative Study

Lung cancer is the leading cause of cancer mortality among American Indian and Alaska Native populations. American Indian and Alaska Native people use commercial tobacco products at higher rates compared with all other races and ethnicities. Moreover, they show lower adherence to cancer screening guidelines. How do American Indian and Alaska Native adults perceive and use lung cancer screening? We conducted a study in which we recorded and transcribed data from three focus groups consisting of American Indian and Alaska Native adults. Participants were recruited through convenience sampling at a national health conference. Transcripts were analyzed by inductive coding. Participants (n= 58) of 28 tribes included tribal Elders, tribal leaders, and non-Native volunteers who worked with tribal communities. Limited community awareness of lung cancer screening, barriers to lung cancer screening at health care facilities, and health information-seeking behaviors emerged as key themes in discussions. Screening knowledge was limited except among people with direct experiences of lung cancer. Cancer risk factors such as multigenerational smoking were considered important priorities to address in communities. Limited educational and diagnostic resources are significant barriers to lung cancer screening uptake in addition to limited discussions with health care providers about cancer risk. Limited access to and awareness of lung cancer screening must be addressed. American Indian and Alaska Native adults use several health information sources unique to tribal communities, and these should be leveraged in designing screening programs. Equitable partnerships between clinicians and tribes are essential in improving knowledge and use of lung cancer screening.

Determinants of Willingness to Undergo Lung Cancer Screening among High-Risk Current and Ex-smokers in Sabah, Malaysia: A Cross-Sectional Pilot Study.

Attitudes towards smoking, lung cancer screening, and perceived risk of lung cancer have not been widely studied in Malaysia. The primary objective of this study was to describe the factors affecting the willingness of high-risk current smokers and ex-smokers to undergo low-dose computed tomography (LDCT) screening for lung cancer. A prospective, cross-sectional questionnaire study was conducted in current smokers or ex-smokers aged between 55 and 80 years at three hospitals in Kota Kinabalu, Sabah, Malaysia. The questionnaire recorded the following parameters: perceived lung cancer risk; Prostate Lung Colon Ovarian Cancer 2012 risk prediction model excluding race and ethnicity predictor (PLCOm2012norace); demographic characteristics; psychosocial characteristics; and attitudes towards lung cancer and lung cancer screening. A vast majority of the 95 respondents (94.7%) indicated their willingness to undergo screening. Stigma of lung cancer, low levels of knowledge about lung cancer symptoms, concerns about financial constraints, and a preference for traditional medication were still prevalent among the respondents, and they may represent potential barriers to lung cancer screening uptake. A desire to have an early diagnosis (odds ratio [OR], 11.33; 95% confidence interval [CI], 1.53 to 84.05; p=0.02), perceived time constraints (OR, 3.94; 95% CI, 1.32 to 11.73; p=0.01), and proximity of LDCT screening facilities (OR, 14.33; 95% CI, 1.84 to 111.4; p=0.01) had significantly higher odds of willingness to undergo screening. Although high-risk current smokers and ex-smokers are likely to undergo screening for lung cancer, several psychosocial barriers persist. The results of this study may guide the policymakers and clinicians regarding the need to improve lung cancer awareness in our population.

Patient-Provider Discussion About Lung Cancer Screening by Race and Ethnicity: Implications for Equitable Uptake of Lung Cancer Screening

BackgroundPhysician-patient discussions regarding lung cancer screening (LCS) are uncommon and its racial and ethnic disparities are under-investigated. We examined the racial and ethnic disparities in the trends and frequency of LCS discussion among the LCS-eligible United States (US) population. MethodsWe analyzed data from the Health Information National Trends Survey from 2014 to 2020. LCS-eligible individuals were defined as adults aged 55 to 80 years old who have a current or former smoking history. We estimated the trends and frequency of LCS discussions and adjusted the probability of having an LCS discussion by racial and ethnic groups. ResultsAmong 2136 LCS-eligible participants (representing 22.7 million US adults), 12.9% (95% CI, 10.9%-15%) reported discussing LCS with their providers in the past year. The frequency of LCS discussion was lowest among non-Hispanic White participants (12.3%, 95% CI, 9.9%-14.7%) compared to other racial and ethnic groups (14.1% in Hispanic to 15.3% in non-Hispanic Black). A significant increase over time was only observed among non-Hispanic Black participants (10.1% in 2014 to 22.1% in 2020; P = .05) and non-Hispanic Whites (8.5% in 2014 to 14% in 2020; P = .02). In adjusted analyses, non-Hispanic Black participants (14.6%, 95% CI, 12.3%-16.7%) had a significantly higher probability of LCS discussion than non-Hispanic Whites (12.1%, 95% CI, 11.4%-12.7%). ConclusionPatient-provider LCS discussion was uncommon in the LCS-eligible US population. Non-Hispanic Black individuals were more likely to have LCS discussions than other racial and ethnic groups. There is a need for more research to clarify the discordance between LCS discussions and the actual screening uptake in this population.

Understanding Factors Associated with Uptake of Lung Cancer Screening among Individuals at High Risk.

Early detection using low-dose computed tomography scanning reduces lung cancer-specific mortality by 20% among high-risk individuals. Despite its efficacy, the uptake of lung cancer screening (LCS) remains low. This study aimed to identify factors associated with the uptake of LCS in high-risk individuals. Data for this study were obtained from the Behavioral Risk Factor Surveillance System (n=11,297). Multivariable logistic regression models were used. Individuals with no health insurance (OR: 0.33, 95% CI: 0.19-0.58), no primary health care provider (OR: 0.40, 95% CI: 0.25-0.64), no chronic obstructive pulmonary disease (OR: 0.37, 95% CI: 0.28- 0.49), and racial/ethnic minorities other than Black and Hispanic (OR: 0.49, 95% CI: 0.31-0.78) were less likely to participate in annual LCS. Low-dose computed tomography uptake varied widely across the 24 U.S. states. The findings from this study have important implications for designing more effective interventions to target specific U.S. states and subgroups for the uptake of annual LCS.

Abstract 787: Lung cancer screening use before &amp; during the COVID-19 pandemic in the US: Population-based evidence from 2019-2021

Abstract Introduction: Lung cancer is the leading cause of cancer-related death in the US with an estimated 236,740 new cases and 130,180 deaths expected in 2022. While early detection with low-dose computed tomography reduces lung cancer mortality by at least 20%, there has been a low uptake of lung cancer screening (LCS) use in the US. The COVID-19 pandemic caused significant disruption in cancer screening. Yet, little is known about how COVID-19 impacted already low use of LCS. This study aims to estimate LCS use before (2019) and during (2020 and 2021) the COVID-19 pandemic among LCS-eligible population in the US. Methods: We used population-based, nationally representative, cross-section data from the 2019 (n=4,484), 2020 (n=1,239) and 2021 (n=1,673) Behavioral Risk Factor Surveillance System, Lung Cancer Screening module. The outcome was self-reported LCS use among eligible adults in the past 12 months. For 2019 and 2020, the eligibility was defined based on US Preventive Services Task Force (USPSTF) initial criteria—adults aged 55 to 80 years old, who were current and former smokers (had quit within the past 15 years) with at least 30 pack years of smoking history. For 2021, we used the USPSTF updated criteria— adults aged 50 to 80 years, current and former smokers (who had quit within the past 15 years) with at least 20 pack years of smoking history. We applied sampling weights to account for the complex survey design to generate population estimates and conducted weighted descriptive statistics and logistic regression models. Results: Overall, there were an estimated 1,559,137 LCS-eligible respondents from 16 US states in 2019 (AZ, ID, KY, ME, MN, MS, MT, NC, ND, PA, RI, SC, UT, VT, WV, WI), 200,301 LCS-eligible respondents from five states in 2020 (DE, ME, NJ, ND, SD), and 668,359 LCS-eligible respondents from four states in 2021 (ME, MI, NJ, RI). Among 2,427,797 LCS-eligible adults, 254,890; 38,875; and 122,240 individuals reported receiving LCS in 2019, 2020 and 2021, respectively. Overall, 16.4% (95% CI 14.4-18.5), 19.4% (95% CI 15.3-24.3), and 18.3% (95% CI 15.6-21.3) received LCS during 2019, 2020, and 2021, respectively. In all years, the proportion of LCS use was higher among adults aged 65-74, insured, those with fair and poor health, lung disease and history of cancer (other than lung cancer). In 2020, a higher proportion of adults living in urban areas reported receiving LCS compared to those living in rural areas (20.36% vs. 12.7%, p=0.01). Compared to non-Hispanic White adults, the odds of receiving LCS was lower among Hispanic adults and higher among Non-Hispanic American Indian/Alaskan Native adults in 2020 and 2021, respectively. Conclusion: LCS uptake remains low in the US. An estimated 2,011,792 adults at high-risk for developing lung cancer did not receive LCS during 2019, 2020 and 2021. Efforts should be focused to increase LCS awareness and uptake across the US to reduce lung cancer burden. Citation Format: Hermine Poghosyan, Sayantani Sarkar, Ilana Richman. Lung cancer screening use before &amp; during the COVID-19 pandemic in the US: Population-based evidence from 2019-2021 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 787.

Cross-sectional review of US websites providing lung cancer screening recommendations following the 2021 US Preventive Services Task Force updates

BackgroundLung cancer remains the leading cause of cancer death worldwide and an urgent public health priority. Early detection by low-dose CT (LDCT) screening and treatment of lung cancer has been shown to reduce mortality but uptake remains dismal, particularly among historically underserved groups. Following the US Preventive Services Task Force (USPSTF) expansion of its eligibility criteria to address inequities in utilization, efforts are needed to ensure dissemination of updated health information through digital means such as websites. ObjectiveThe objective of this study was to investigate whether online websites have been updated to reflect the recent USPSTF guidelines that expanded the recommended age and smoking pack-years for lung cancer screening. MethodsIn this cross-sectional study, we identified websites that provide information on lung cancer screening guidelines on May 24, 2022, approximately one year after the emergence of the updated USPSTF guidelines. The websites were assessed for recommended age to begin lung cancer screening and smoking pack-year quantity. ResultsOur study found that a lag in dissemination of updated lung cancer screening information exists. Approximately 1 year after the USPSTF guidelines were updated, 17–32% of websites providing information on lung cancer screening guidelines had not been updated. ConclusionRoutine monitoring of websites that provide information on lung cancer screening can help reduce misinformation, improve uptake of lung cancer screening, and prevent delays in diagnostic evaluation which disproportionally affects traditionally underserved populations.

Interventions Designed to Increase the Uptake of Lung Cancer Screening: An Equity-Oriented Scoping Review

IntroductionParticipation in lung cancer screening (LCS) is lower in populations with the highest burden of lung cancer risk (through the social patterning of smoking behavior) and lowest levels of health care utilization (through structurally inaccessible care) leading to a widening of health inequities. MethodsWe conducted a scoping review using the Arksey and O’Malley methodological framework to inform equitable access to LCS by illuminating knowledge and implementation gaps in interventions designed to increase the uptake of LCS. We comprehensively searched for LCS interventions (Ovid Medline, Excerpta Medica database, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and Scopus from 2000 to June 22, 2021) and included peer-reviewed articles and gray literature published in the English language that describe an intervention designed to increase the uptake of LCS, charted data using our previously published tool and conduced a health equity analysis to determine the intended-unintended and positive-negative outcomes of the interventions for populations experiencing the greatest inequities. ResultsOur search yielded 3572 peer-reviewed articles and 54,292 pieces of gray literature. Ultimately, we included 35 peer-reviewed articles and one gray literature. The interventions occurred in the United States, United Kingdom, Japan, and Italy, focusing on shared decision-making, the use of electronic health records as reminders, patient navigation, community-based campaigns, and mobile computed tomography scanners. We developed an equity-oriented LCS framework and mapped the dimensions and outcomes of the interventions on access to LCS on the basis of approachability, acceptability, availability, affordability, and appropriateness of the intervention. No intervention was mapped across all five dimensions. Most notably, knowledge and implementation gaps were identified in dimensions of acceptability, availability, and affordability. ConclusionsInterventions that were most effective in improving access to LCS targeted priority populations, raised community-level awareness, tailored materials for sociocultural acceptability, did not depend on prior patient engagement/registration with the health care system, proactively considered costs related to participation, and enhanced utilization through informed decision-making.

Abstract A086: Disparities in lung cancer screening uptake across the United States

Abstract Background: Despite the efficacy of low-dose computerized tomography (LDCT) to detect lung cancer early, the rate of lung cancer screening among high-risk individuals remains low. The purpose of this study was to assess lung cancer screening rates in contrast with state lung cancer mortality across the United States. Methods: Data for this study were obtained from the Behavioral Risk Factor Surveillance System (BRFSS) from three consecutive years (2018-2020); a population-based survey administered via cell phone and landline and conducted annually by the Centers for Disease Control and Prevention (CDC). Eligibility criteria follow the 2013 U.S. Preventive Services Task Force (USPSTF) recommendation: high-risk individuals aged 55-80 years with a &amp;gt;30 pack-year smoking history who currently smoke or have quit within the past 15 years. After excluding ineligible subjects and those with missing information, 11,297 subjects were included in the final analysis. Multivariable logistic regression models were used to assess the association between the predictor (i.e., state of residence) and the outcome variable (i.e., screening rate). Results: Of the 24 states included in this study, the states with the highest lung cancer screening rates were Rhode Island (24.75%), Vermont (22.51%), New Jersey (21.72%), Minnesota (21.64%), and Delaware (21.39%). The states with the lowest screening uptake were Oklahoma (9.23%), Utah (9.78%), West Virginia (12.23%), South Dakota (12.31%), and Kansas (12.41%). Kentucky has the highest lung cancer mortality and has become the 6th highest in screening rates. Utah has the lowest lung cancer mortality and is the second-lowest state in lung cancer screening rates. After adjusting for sociodemographic (i.e., age, gender, marital status, level of education, income, insurance, and race/ethnicity) and health-related factors (i.e., chronic obstructive pulmonary disease, smoking history, and primary care provider), high-risk individuals in the state of Delaware (OR: 2.85, 95% CI: 1.50 - 5.41), Kentucky (OR: 2.04, 95% CI: 1.03 - 4.04), Minnesota (OR: 2.74, 95% CI: 1.49 - 5.06), Montana (OR: 2.15, 95% CI: 1.09 - 4.25), New Jersey (OR: 2.39, 95% CI: 1.25 - 4.57), Pennsylvania (OR: 2.28, 95% CI: 1.17 - 4.44), Rhode Island (OR: 2.57, 95% CI: 1.33 - 4.98), Texas (OR: 4.51, 95% CI: 2.04 - 9.97) and Vermont (OR: 3.18, 95% CI: 1.61 - 6.28) were significantly more likely to receive lung cancer screening than those in Utah. High-risk individuals in all the remaining states were not significantly different in terms of their lung cancer screening rates compared to Utah. Conclusions: Lung cancer screening rates varied widely across 24 states and did not match with the lung cancer mortality burden in each state. The results from the present study highlights the importance of developing targeted initiatives and policies that enhance the rates of lung cancer screenings in the states that experience a disproportionate burden of lung cancer mortality. Citation Format: Abdi Gudina, M. Patricia Rivera, Charles Kamen, AnaPaula Cupertino. Disparities in lung cancer screening uptake across the United States [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A086.

Abstract A101: Exploring facilitators and barriers to low-dose CT screening for lung cancer among Native American patients: The TEALS study

Abstract Purpose: Lung cancer screening (LCS) with low dose CT scanning reduces mortality but uptake of LCS is poor. Lung cancer mortality in Oklahoma’s Native American population is 45% higher than for the non-Hispanic White population. The Tribally Engaged Approaches to Lung Screening (TEALS) study is a collaboration between the University of Oklahoma Health Sciences Center and the Choctaw Nation of Oklahoma Health Services Authority (CNHSA). The goals of TEALS are to implement a systematic LCS program within Choctaw Nation and to understand LCS decision-making processes, barriers and facilitators. Procedures: Using purposive sampling from 2 of 8 CNHSA clinics in Oklahoma in 2021, we conducted a pilot study using phone interviews with patients who had completed LCS and those who had not. Using a semi-structured interview guide, we asked patients about their experience with the LCS program, factors that influenced their decision, and suggestions for improving the program. Conventional inductive content analysis was used to identify major themes. Multiple coders and peer debriefing enhanced scientific rigor. Results: Completers (4 men and 5 women) and non-completers (3 men and 3 women) were included. Major themes included: (1) Contextual factors influencing the decision-making process; (2) Individual characteristics influencing the decision-making process; and (3) Barriers to screening. Contextual factors included the provider raising the discussion of LCS, which was most frequently cited by completers but not the non-completers. Other contextual factors included the use of handouts and pamphlets during clinic visits. Patient suggestions included brochures/posters in waiting rooms and creating an information video to run on TVs in waiting areas. Individual characteristics included motivation to ‘be there’ for family/children, previous cancer in family/friends, and ease of arranging appointments. Non-completers preferred not to know or were scared to know the results of screening. Barriers included long distance travel to LCS sites, missing work, access to transportation or assistance, confusion about the appointment leading to missed appointments. Interviews highlighted the need to clarify eligibility criteria. Notably, some patients who were classified as ‘non-completers’ had already had a diagnostic CT for respiratory symptoms or as follow-up for prior cancer, indicating a gap in correctly identifying LCS eligibility. Conclusions: Findings from this pilot have guided implementation of the TEALS clinical trial. Large banners are now available in participating clinics. Academic detailing ensures the decision aid pamphlet is available and used in waiting rooms. Providers are reminded of the critical role they play in informing patients about LCS. Appointment reminders and assistance with transportation (e.g., tribal transportation) are in place. Eligibility criteria for the clinical trial have been clarified. Gathering this information from pilot study participants has enabled the team to refine the LCS intervention as it expands to other sites. Citation Format: Kathleen Dwyer, Dorothy A. Rhoades, Mark Doescher, Brook McCann, Michele Gibson, Zsolt Nagykaldi. Exploring facilitators and barriers to low-dose CT screening for lung cancer among Native American patients: The TEALS study [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A101.

Abstract A116: Evaluating medical mistrust in efforts to promote equity in lung cancer screening implementation

Abstract Purpose: Lung cancer is the leading cause of cancer death in the U.S. Lung cancer screening significantly reduces lung cancer mortality, but national uptake is low (&amp;lt;6%). Black and low-income Americans have higher lung cancer mortality rates and lower lung cancer screening rates than White and high-income Americans, respectively. Lower lung cancer screening uptake among Black and low-income populations may widen existing disparities in lung cancer mortality. Prior studies have found higher levels of medical mistrust among Black and low-income populations, perhaps arising from structural racism and other inequities. Indeed, medical mistrust may reduce cancer screening intentions, but little is known about how health systems can promote lung screening uptake while earning patient trust. To address this gap, this study aimed to identify diverse patient perspectives on increasing equity in lung screening uptake and addressing medical mistrust. Methods: We conducted 20 semi-structured interviews and four focus groups (about four participants per group) with a diverse sample of lung cancer screening-eligible individuals throughout the U.S. (i.e., individuals aged 50-80 years with eligible smoking histories). Interviews and focus groups investigated participant awareness of lung screening, barriers to screening, the role of medical mistrust in screening uptake, and perspectives on equitable screening implementation. We used an iterative inductive/deductive content analysis approach to identify key themes from interview and focus group transcripts. Results: Interview participants (n=20) were 60 years of age on average and had a mean smoking pack-year history of 42.5 years. Half of interview participants identified as Black (50%), slightly more than half of participants had a household income of &amp;lt;$30,000 (55%), and most participants were female (60%). Focus group participants had similar demographics. Most participants were unaware of lung cancer screening but were eager to learn more. As a key barrier, participants discussed that their doctors had never mentioned lung screening, which confused and frustrated participants who had long-term relationships with primary care doctors. Prior negative healthcare experiences (e.g., misdiagnoses and having serious symptoms dismissed by healthcare providers) were also discussed as screening barriers as they engendered mistrust and hesitancy to seek future care. Several Black participants cited personal and vicarious experiences of racism in the healthcare system as key barriers contributing to mistrust and screening hesitancy. Lastly, participants raised several suggestions to promote equitable screening implementation, such as the need to meaningfully engage with communities to raise screening awareness and address cost issues. Conclusions: Lung cancer screening interventions may be more successful if concerted efforts are taken to understand and address medical mistrust. Future work is needed to address the reasons patients may mistrust healthcare providers and systems that deliver lung cancer screening. Citation Format: Jennifer Richmond, Jessica R. Fernandez, Kemberlee R. Bonnet, Maria A. Pena, Allana T. Forde, David G. Schlundt, Consuelo H. Wilkins, Melinda C. Aldrich. Evaluating medical mistrust in efforts to promote equity in lung cancer screening implementation [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A116.