PROJECT SUMMARY:
Lung cancer is the leading cause of cancer death, and lung cancer screening (LCS) can reduce lung cancer-
related mortality by 20%. However, only 5-10% of eligible individuals have received an initial LCS exam, with
Black and Hispanic individuals less likely to be screened and more likely to suffer delays in diagnosis and
treatment, contributing to higher mortality from lung cancer. Community health workers (CHWs) are an
effective strategy to promote screening and mitigate disparities in other cancer settings. Whether CHWs can
be effective in the context of LCS and address key barriers to receiving LCS remains unknown. The goal of this
study is to develop and pilot test a four-part CHW intervention to improve LCS uptake and mitigate disparities,
which includes: 1) patient outreach, 2) patient-centered shared decision-making, 3) smoking cessation
counseling, and 4) navigation of logistical barriers. Our central hypothesis, based on our qualitative work and
informed by the expanded Health Belief Model, posits that CHWs can address key modifiable factors to
improve LCS awareness, engagement, and barriers to accessing care, leading to increased LCS uptake
overall and among Black and Hispanic communities. Our aims are to: Jointly “transcreate” a CHW intervention
to increase LCS uptake among patients served by community health centers (Aim 1); conduct a pilot
randomized controlled trial of the CHW intervention (Aim 2a); and obtain empiric estimates of effect size in
LCS and tobacco treatment utilization (Aim 2b). We first seek to jointly “transcreate” a CHW intervention with
our community advisory board, comprised of key stakeholders in LCS and patients with lived experience,
applying the Transcreation Framework for Community-Engaged Behavioral Interventions to Reduce Health
Disparities. Then we will conduct a pilot randomized controlled trial of the CHW intervention at Baystate
Health’s three community health centers. We will randomize 80 LCS-eligible individuals (40 in each arm) to
either the CHW-led intervention or enhanced usual care (i.e., mailed LCS educational materials and usual LCS
as per primary care provider). Primary pilot outcomes are focused on feasibility, including participant
recruitment, measure completion, retention, fidelity, and acceptability. We will also conduct an evaluation of
secondary trial outcomes, including LCS and tobacco treatment utilization, as well as explore potential
mediators (e.g., knowledge, facilitation of logistical barriers). The proposed activities will provide me crucial
skills in health equity research, implementation science, and clinical trial design, and launch my career as a
clinician-scientist dedicated to addressing health disparities. This work will also lay the groundwork for a
subsequent R01 grant conducting a fully powered randomized controlled trial of the CHW intervention that
directly addresses top priorities from the President’s Cancer Moonshot and NCI’s mission to develop multi-
level interventions that facilitate equitable access to cancer screening and reduce lung cancer mortality.
