Am J Prev Med. 2024 Sep 27:S0749-3797(24)00332-5. doi: 10.1016/j.amepre.2024.09.016. Online ahead of print.

ABSTRACT

INTRODUCTION: A lung cancer screening program using low dose CT (LDCT) in a Federally Qualified Health Center (FQHC) in Central Texas was developed and assessed for equitable implementation.

METHODS: From 11/2020-8/2023, patients aged 55-77 years who currently smoked or quit within 15 years with ≥ 20 pack-years of exposure were identified through EHR query and mailed outreach, or through direct provider referrals. A bilingual social worker confirmed eligibility, provided tele-care shared decision-making (SDM), coordinated screening, and offered smoking cessation. To assess equity, LDCT completion across demographics was compared, in 2023.

RESULTS: 6,486 patients were mailed outreach materials; 479 patients responded, of whom 108 (22.5%) were eligible and 71 (65.7%) participated in SDM. 629 eligible patients were referred internally; 579 (92.0%) completed SDM. Of the 650 patients who completed SDM, 636 (97.8%) agreed to screening. Mean age was 61.7; 38.1% were female. The population was diverse: 35.8% identified as Latino, 17.8% as African-American, 26.8% had Medicare or Medicaid, 48.0% used the county medical assistance program, 14.2% were uninsured, and 76.7% currently smoked. Overall, 528 (83.0%) patients completed LDCT. There were no statistically significant differences in completion by age, gender, race/ethnicity, or insurance status. Spanish-speaking patients were more likely to complete the CT than English speakers (OR 2.22, 95% CI 1.22, 4.41) and those who formerly smoked were more likely to complete the CT than patients who currently smoked (OR 1.93, 95% CI 1.12, 3.51).

CONCLUSIONS: The navigator-centered program achieved equitable implementation of lung cancer screening in a diverse FQHC system.

PMID:39343325 | DOI:10.1016/j.amepre.2024.09.016