https://orcid.org/0000-0003-0837-9281
Abstract
African American individuals experience disparities in the burden of lung cancer compared to other racial or ethnic groups. Yet, African Americans are less likely than White patients to have provider-initiated discussions about lung cancer screening (LCS). In addition to provider-level barriers, predictors of racial disparities include patient-level knowledge barriers and medical mistrust. This study assessed the feasibility and acceptability of provider- and patient-oriented approaches to increase uptake of LCS in a majority African American primary care clinic setting.
In Phase 1, we conducted surveys (N = 22) and usability testing with providers (N = 7) to develop a previsit planning message, a type of clinician reminder. The clinician reminder is sent via the electronic health record ahead of scheduled visits with screening-eligible participants to promote LCS discussion. We partnered with a primary care clinic (N = 5 providers; N = 399 patients 50–80 years old with a documented smoking history, no prior lung cancer diagnosis) to evaluate the impact of the reminder on LCS referral rates. In Phase 2, we conducted a pretest-posttest study (N = 16) to pilot a previsit phone-based patient education session. Patient-level LCS knowledge was assessed using 10 true/false items and a single item measured screening intentions.
In Phase 1, LCS referrals increased from 6 6-months prepilot to 49 during the 6-month pilot period. The majority (89.8%) of the orders placed had a clinician reminder. In Phase 2, from pretest to posttest, there was improvement in LCS knowledge (mean percent correct: 63.3% to 76.7%; P = .013) and screening intentions (43.8% to 82%; P = .05).
In a diverse clinical setting, we developed a feasible and acceptable multilevel approach aimed at increasing LCS equitably.
The Clinical Trials Registration #NCT04675476.
Lay Summary
Lung cancer is the leading cause of cancer death in the United States. African Americans are less likely to be diagnosed early with lung cancer. People who take part in lung cancer screening can lower their chances of dying from lung cancer. Lung cancer screening is recommended for older adults with a history of smoking. However, many African Americans who are eligible for lung screening do not get the test. There are several health system, provider, and patient barriers that stand in the way of people getting the test. This study developed a provider reminder and patient education intervention to promote lung cancer screening. In this pilot study, the provider reminder increased provider referrals for lung cancer screening and the patient education intervention increased patient knowledge about screening. In a future study, we will test the provider reminder and patient education together to increase lung cancer screening among African American patients.
