PROJECT SUMMARY/ABSTRACT
Lung cancer is the leading cause of cancer death in the United States, and lung cancer screening has been
demonstrated to effectively reduce lung cancer by 20-26% in eligible patients. Despite 10 years of
recommendations endorsing screening, evidence suggests that real-world implementation of screening along
the care continuum has been poor. Specifically, prior work reveals that adherence to routine annual screening
and specialized follow-up after positive lung cancer screening exams is suboptimal, with a median adherence
of 40-60% across clinical programs. Follow-up after either negative or positive lung cancer screening is a
critical target to achieve mortality benefits seen in clinical trials, as adherence to follow-up was >90% in these
studies, and more than half of all screen-detected lung cancers were diagnosed in follow-up.
Prior studies of adherence to follow-up been largely observational, single center and performed in academic
settings, but have demonstrated that clinical lung cancer screening programs which contain centralized
program-level interventions such as care coordination have two-to-three times the rate of follow-up adherence
compared to programs where lung cancer screening is largely managed by primary providers. Prior
observational work also suggests centralized programmatic interventions may mitigate health disparities in
lung cancer screening. It is therefore critical to prospectively evaluate feasible and effective centralized
program interventions in community settings to translate the benefits to screening programs and patients.
To fill this important knowledge gap, the central objective of this study is to generate evidence of barriers
and facilitators to lung cancer screening follow-up in decentralized community programs, adapt and introduce
centralizing interventions in these settings and rigorously measure the effectiveness and implementation of
these interventions. This objective will be met by achievement of three specific aims performed at 3 non-
academic regional partnering sites with large rural and Hispanic populations. In the first aim, we will determine
system-, provider- and patient-level facilitators to LCS follow-up in these settings using an innovative rapid
ethnographic approach supplemented by semi-structure interviews. In the second aim, we will adapt and
evaluate centralizing interventions including defined care pathways and after-screening care coordination
measuring the impact on adherence and socioeconomic, rural-urban and racial-ethnic disparities. Finally in the
third aim, we will evaluate the implementation of these strategies with a key focus on the tension between
fidelity and adaptations as these interventions mature. The aims will be grounded in an integration of the
Consolidative Framework of Implementation Research, RE-AIM and a NIH-developed health disparities
framework. Our team has extensive experience in lung cancer screening implementation and disparities with
expertise in adapting and evaluating pragmatic interventions in community settings. This project will generate
essential knowledge to improve lung cancer screening follow-up in real-world clinical programs.
