A Community Health Intervention to Improve Lung Cancer Screening Uptake in Community Health Centers

Summary

Lung cancer screening (LCS) can reduce lung cancer-related mortality, but screening uptake remains low among eligible individuals. The goal of this study is to partner with community stakeholders to develop and pilot test a multi-component navigator-delivered intervention targeting key barriers to lung cancer screening and tobacco treatment utilization. Participants are randomized to enhanced usual care, a community health worker (CHW)-delivered intervention, or the same intervention delivered by a trained lay navigator. The intervention includes patient outreach, patient-centered shared decision-making, tobacco treatment counseling, and assistance navigating logistical barriers to care. The proposed activities will lay the groundwork for a subsequent fully powered randomized clinical trial evaluating CHW- and lay navigator-delivered approaches to facilitate access to lung cancer screening and tobacco treatment.

Detailed Description

Lung cancer is a leading cause of cancer death, and lung cancer screening (LCS) with low-dose computed tomography can reduce lung cancer-related mortality among eligible individuals. However, uptake of LCS remains low, particularly among populations that face barriers to accessing preventive care. Community health worker (CHW) interventions have been effective at promoting screening and reducing barriers to care in other cancer settings. This study was designed to develop and pilot test a multi-component intervention intended to improve LCS uptake and tobacco treatment utilization. The intervention includes four components: 1) patient outreach, 2) patient-centered shared decision-making about lung cancer screening, 3) tobacco treatment counseling for participants who currently smoke, and 4) navigation of logistical barriers to care. The intervention was developed in partnership with a community advisory board composed of community stakeholders and individuals with lived experience, using principles from the Transcreation Framework for Community-Engaged Behavioral Interventions. The pilot randomized controlled trial is being conducted within Baystate Health community health centers. Participants are randomized to one of three study arms: 1) enhanced usual care, which includes mailed lung cancer screening educational materials and usual screening care through the participant's primary care provider; 2) the multi-component intervention delivered by a community health worker; or 3) the same multi-component intervention delivered by a trained lay navigator, such as a research assistant or pre-medical student. The study will evaluate the feasibility of implementing the intervention using different navigator models. Primary pilot outcomes include participant recruitment, measure completion, retention, intervention fidelity, and acceptability. Secondary outcomes include lung cancer screening and tobacco treatment utilization. The study will also explore potential mechanisms through which the intervention may influence screening, including knowledge about lung cancer screening and assistance overcoming logistical barriers to care. Findings from this pilot study will inform the design of a future, fully powered randomized controlled trial evaluating approaches to improving access to lung cancer screening and tobacco treatment.

Eligibility Criteria

Interventions