Universal Tobacco Screening and Opt-Out Treatment Referral Strategy Among Patients Diagnosed With Cancer by Race and Ethnicity.

This quality improvement study examines whether a universal screening and opt-out referral model could promote racial and ethnic equity in access and use of tobacco treatment among patients with cancer.

A pragmatic randomized clinical trial of multilevel interventions to improve adherence to lung cancer screening (The Larch Study): Study protocol.

BACKGROUND: In real-world settings, low adherence to lung cancer screening (LCS) diminishes population-level benefits of reducing lung cancer mortality. We describe the Larch Study protocol, which tests the effectiveness of two patient-centered interventions (Patient Voices Video and Stepped Reminders) designed to address barriers and improve annual LCS adherence. METHODS: The Larch Study is a pragmatic randomized clinical trial conducted within Kaiser Permanente Washington. Eligible patients (target n = 1606) are aged 50-78 years with an index low-dose CT (LDCT) of the chest with negative or benign findings. With a 2 × 2 factorial-design, patients are individually randomized to 1 of 4 arms: video only, reminders only, both video and reminders, or usual care. The Patient Voices video addresses patient education needs by normalizing LCS, reminding patients when LCS is due, and encouraging social support. Stepped Reminders prompts primary care physicians to order patient's repeat screening LDCT and patients to schedule their scan. Intervention delivery is embedded within routine healthcare, facilitated by shared electronic health record components. Primary outcome is adherence to national LCS clinical guidelines, defined as repeat LDCT within 9-15 months. Patient-reported outcomes are measured via survey (knowledge of LCS, perception of stigma) approximately 8 weeks after index LDCT. Our mixed-methods formative evaluation includes process data, collected during the trial, and interviews with trial participants and stakeholders. DISCUSSION: Results will fill an important scientific gap on multilevel interventions to increase annual LCS adherence and provide opportunities for spread and scale to other healthcare settings. REGISTRATION: Trial is registered at clinicaltrials.gov (#NCT05747443).

Patient Navigation Plus Tailored Digital Video Disc Increases Colorectal Cancer Screening Among Low-Income and Minority Patients Who Did Not Attend a Scheduled Screening Colonoscopy: A Randomized Trial.

BACKGROUND: Up to 50% of people scheduled for screening colonoscopy do not complete this test and no studies have focused on minority and low-income populations. Interventions are needed to improve colorectal cancer (CRC) screening knowledge, reduce barriers, and provide alternative screening options. Patient navigation (PN) and tailored interventions increase CRC screening uptake, however there is limited information comparing their effectiveness or the effect of combining them. PURPOSE: Compare the effectiveness of two interventions to increase CRC screening among minority and low-income individuals who did not attend their screening colonoscopy appointment-a mailed tailored digital video disc (DVD) alone versus the mailed DVD plus telephone-based PN compared to usual care. METHODS: Patients (n = 371) aged 45-75 years at average risk for CRC who did not attend a screening colonoscopy appointment were enrolled and were randomized to: (i) a mailed tailored DVD; (ii) the mailed DVD plus phone-based PN; or (iii) usual care. CRC screening outcomes were from electronic medical records at 12 months. Multivariable logistic regression analyses were used to study intervention effects. RESULTS: Participants randomized to tailored DVD plus PN were four times more likely to complete CRC screening compared to usual care and almost two and a half times more likely than those who were sent the DVD alone. CONCLUSIONS: Combining telephone-based PN with a mailed, tailored DVD increased CRC screening among low-income and minority patients who did not attend their screening colonoscopy appointments and has potential for wide dissemination.

Up to half of people scheduled for a screening colonoscopy do not complete this test. There is a need for interventions to improve knowledge about colorectal cancer (CRC) screening, enhance access to screening by offering alternative test options, foster skills for completing screening, and mitigate barriers. The purpose of this study was to compare the effects of two interventions aimed at increasing CRC screening­a mailed tailored digital video disc (DVD) alone versus the mailed DVD plus telephone-based patient navigation (PN)­for patients who had not completed a scheduled screening colonoscopy. We enrolled 371 patients aged 45­75 years who had no CRC risk factors other than age, who were scheduled for a screening colonoscopy but did not attend their appointment. Participants were randomized to receive either: (i) a mailed tailored DVD; (ii) the mailed DVD plus phone-based PN; or (iii) usual care. Those who received the tailored DVD plus PN were four times more likely to complete CRC screening with stool test or colonoscopy compared to usual care. Combining telephone-based PN with a mailed, tailored DVD increased CRC screening among low-income and minority patients who did not attend a scheduled screening colonoscopy appointment.

Unpacking the relationship between shared decision-making and decisional quality, decision to screen, and screening completion in lung cancer screening.

OBJECTIVES: Lung cancer screening is a complex and individualized decision. To understand how best to support patients in this decision, we must understand how shared decision-making is associated with both decisional and behavioral outcomes. METHODS: Observational cohort study combining patient survey data with electronic health record data of lung screening-eligible patients who recently engaged in a shared decision-making discussion about screening with a primary care clinician. RESULTS: Using multivariable analysis (n = 529), factors associated with higher lung cancer screening decisional quality include higher knowledge (OR = 1.33, p < .0001), lower perceived benefits (OR = 0.90, p = .0004), higher perceived barriers (OR = 1.07, p < .0001), higher self-efficacy (OR = 1.13, p < .0001), and higher levels of perceiving the discussion was shared (OR = 1.04, p < .0001). Factors associated with the patient's decision to screen include older age (OR = 1.12, p = .0050) and higher self-efficacy (OR = 1.11, p = .0407). Factors associated with screening completion included older age (OR = 1.05, p = .0050), higher knowledge (OR = 1.24, p = .0045), and higher self-efficacy (OR = 1.12, p = .0003). CONCLUSIONS: Shared decision-making in lung cancer screening is a dyadic process between patient and clinician. As we continue to strive for high-quality patient-centered care, patient decision quality may be enhanced by targeting key factors such as high-quality knowledge, self-efficacy, and fostering a shared discussion to support patient engagement in lung cancer screening decisions.

Effective Communication About Lung Cancer Screening Without Iatrogenic Stigma: A Brief Report Case Study Using the Lung Cancer Stigma Communications Assessment Tool of LungTalk.

Introduction: Stigma thwarts progress in lung cancer risk reduction and control and adversely affects patients across the entire lung cancer care continuum. In developing and disseminating patient and public-facing interventions to increase lung screening, we must be cognizant of how communications have the potential for further stigmatization of at-risk populations. Creation of the Lung Cancer Stigma Communications Assessment Tool (LCS-CAT) version 1 was supported by the American Cancer Society's National Lung Cancer Roundtable to help content developers identify, remove, and replace potentially stigmatizing language and imagery from materials designed to engage individuals across the lung cancer continuum. Methods: The LCS-CAT considers language, imagery, and context and was used to audit a public-facing health communication and decision support tool called LungTalk. Results: The audit performed by two behavioral scientists revealed multiple issues in all three areas, and specific feedback and alternatives were identified. Conclusions: Applying the LCS-CAT to LungTalk was a productive process that helped remove potentially stigmatizing language and imagery from this tool designed to engage individuals in the process of making an informed decision about lung screening. To support destigmatization of lung cancer, communication creators should consider a stigma biopsy on all public-facing campaigns for lung screening to help identify, eliminate, and replace messages that could compromise engagement with the lung cancer screening opportunity.

Barriers to Lung Cancer Screening Access from the Perspective of the Patient and Current Interventions.

In the context of the Conceptual Model for Lung Cancer Screening Participation, this article describes patient barriers to lung cancer screening highlighting current interventions. Patient barriers include cognitive factors (lack of awareness, limited information/misinformation, and low perceived risk), factors related to access (logistical issues, no provider recommendation, cost, and other financial/social factors), and psychological factors (fear, fatalism, lung cancer worry, and stigma). Current interventions include the use of educational materials/presentations to address cognitive barriers, use of direct outreach and structural change to address factors related to access, and use of educational material focused on psychological barriers to address psychological barriers.

Getting ready for prime time: Recommended adaptations of an Empathic Communication Skills training intervention to reduce lung cancer stigma for a national multi-center trial.

Building upon prior work developing and pilot testing a provider-focused Empathic Communication Skills (ECS) training intervention, this study sought feedback from key invested partners who work with individuals with lung cancer (i.e. stakeholders including scientific and clinical advisors and patient advocates) on the ECS training intervention. The findings will be used to launch a national virtually-delivered multi-center clinical trial that will examine the effectiveness and implementation of the evidence-based ECS training intervention to reduce patients' experience of lung cancer stigma. A 1-day, hybrid, key invested partners meeting was held in New York City in Fall 2021. We presented the ECS training intervention to all conference attendees (N = 25) to seek constructive feedback on modifications of the training content and platform for intervention delivery to maximize its impact. After participating in the immersive training, all participants engaged in a group discussion guided by semi-structured probes. A deductive thematic content analysis was conducted to code focus group responses into 12 distinct a priori content modification recommendations. Content refinement was suggested in 8 of the 12 content modification themes: tailoring/tweaking/refining, adding elements, removing elements, shortening/condensing content, lengthening/extending content, substituting elements, re-ordering elements, and repeating elements. Engagement and feedback from key invested multi-sector partner is a valuable resource for intervention content modifications. Using a structured format for refining evidence-based interventions can facilitate efforts to understand the nature of modifications required for scaling up interventions and the impact of these modifications on outcomes of interest. ClinicalTrials.gov Identifier: NCT05456841.

This study was done to get feedback from people who are involved with patients with lung cancer (PwLCs) including scientists, clinicians, and patient advocates on training in Empathic Communication Skills (ECS). The training is intended to reduce PwLCs experience of lung cancer stigma. The feedback is being used to help prepare for launching the training program in multiple cancer centers across the USA to test how well the training will work to reduce the stigma felt by PwLCs. A one-day, hybrid (in-person and virtual attendees) meeting was held in New York City in October 2021. We presented the original version of the ECS training program to all conference attendees (N = 25) to get feedback on modifications to improve the training program for the larger study planned at many cancer centers. After the training, all meeting attendees participated in a semi-structured group discussion. The content of the discussion was analyzed and sorted into 12 distinct categories that were defined before the meeting. Changes to the content were suggested in 8 of the 12 categories. These changes included tailoring/tweaking/refining, adding elements, removing elements, shortening/condensing content, lengthening/extending content, substituting elements, re-ordering elements, and repeating elements. Engaging and getting feedback from people involved in a topic is a good way to improve content and delivery of training materials.

Tobacco treatment specialists' knowledge, attitudes and beliefs about lung cancer screening: Potential piece of the puzzle for increasing lung cancer screening awareness.

OBJECTIVES: Less than 5% of eligible U.S. individuals undergo lung cancer screening (LCS). A significant barrier is lack of awareness; more effective outreach and education strategies are needed to achieve greater population LCS uptake. Tobacco Treatment Specialists (TTSs) are an untapped resource to assist and understanding TTS knowledge and perspectives about LCS and readiness and capacity to assist is a critical first step. METHODS: A sequential explanatory mixed-methods study design was conducted to understand LCS knowledge, attitudes, beliefs, and practices of TTSs. A cross-sectional survey (N = 147) was conducted supplemented with 3 focus groups (N = 12). RESULTS: TTSs lacked good working knowledge about LCS in general and screening guidelines, but think it is important for their patient population and open to routinely assessing and adding this educational component into their current workflow. CONCLUSIONS: Tobacco treatment offers a unique venue for LCS awareness and is a setting where there are experienced specialists trained in tobacco use assessment and treatment. Results highlight the unmet training needs required to facilitate integration of tobacco treatment and LCS. PRACTICE IMPLICATIONS: TTSs are an expanding healthcare workforce. There is a strong need for current TTSs to receive additional training in the benefits of LCS.

Leveraging social media to increase lung cancer screening awareness, knowledge and uptake among high-risk populations (The INSPIRE-Lung Study): study protocol of design and methods of a community-based randomized controlled trial.

BACKGROUND: Lung cancer is the leading cause of cancer death for both men and women in the United States. The National Lung Screening Trial (NLST) demonstrated that low-dose computed tomography (LDCT) screening can reduce lung cancer mortality among high-risk individuals, but uptake of lung screening remains low. Social media platforms have the potential to reach a large number of people, including those who are at high risk for lung cancer but who may not be aware of or have access to lung screening. METHODS: This paper discusses the protocol for a randomized controlled trial (RCT) that leverages FBTA to reach screening-eligible individuals in the community at large and intervene with a public-facing, tailored health communication intervention (LungTalk) to increase awareness of, and knowledge about, lung screening. DISCUSSION: This study will provide important information to inform the ability to refine implementation processes for national population efforts to scale a public-facing health communication focused intervention using social media to increase screening uptake of appropriate, high-risk individuals. TRIAL REGISTRATION: The trial is registered at clinicaltrials.gov (#NCT05824273).

Slipping through the cracks: Who is eligible but does not receive a healthcare provider recommendation for lung cancer screening?

INTRODUCTION: Receiving a healthcare provider recommendation to screen is an important predictor for whether individuals at high risk for lung cancer undergo lung cancer screening. Although sociodemographic and socioeconomic characteristics are associated with differential screening participation, it is unknown whether those characteristics are associated with receiving a healthcare provider recommendation for lung cancer screening. METHODS: This cross-sectional study used Facebook-targeted advertising to recruit a national sample of lung cancer screening-eligible adults (N = 515) who completed questionnaires on sociodemographic information (age, gender, race, marital status), socioeconomic characteristics (income, insurance status, education, rurality of residence), smoking status, and receiving a healthcare provider recommendation to screen. Pearson's chi-square tests and independent samples t-tests evaluated whether sociodemographic, socioeconomic, and smoking-related characteristics were associated significantly with receiving a healthcare provider recommendation to screen. RESULTS: Higher household income, having insurance coverage, and being married were associated significantly with receiving a healthcare provider recommendation to screen (all p <.05). Age, gender, race, education, rurality of residence, and smoking status were not associated significantly with receiving a recommendation to screen. DISCUSSION: Particular subgroups of individuals at high risk for lung cancer-including those with lower income, without insurance coverage, and who are not married-are less likely to receive a recommendation to screen from their healthcare provider, despite being at high risk for lung cancer and eligible for screening. Future research should test whether differential screening participation and low screening uptake could be addressed by clinician-focused interventions that encourage ubiquitous discussion and recommendation to undergo screening for people at high risk for lung cancer.

Using social media to recruit individuals for health-related research: Feasibility and lessons learned.

Online recruitment via social media for health-related research is increasing. Metrics regarding social media recruitment may increase its use in this field. This study evaluates the feasibility of recruiting individuals with a smoking history through targeted advertising on Facebook for a randomized study focused on lung cancer screening. Individuals completed eligibility questions and were randomized to one of two groups. We analyzed advertisement reach and response patterns, advertisement cost, data integrity and sample representativeness. The advertisement was active for 34 days and resulted in 2111 unique clicks on the survey link. Four hundred thirty-three eligibility entries were collected, and 61 entries were excluded due to failure to correctly answer the data integrity check. Two hundred eighty-two participants met eligibility criteria and were randomized, 191 participants completed questionnaires and 10 entries were subsequently excluded due to a failed attention check. Recruitment utilizing targeted advertising on Facebook is an effective and efficient strategy for health-related research.

Lung Cancer Screening Knowledge, Attitudes, and Practice Patterns Among Primary and Pulmonary Care Clinicians.

BACKGROUND: Lung cancer screening has the potential to identify lung cancer at an early stage when more treatment options exist. However, discussions with and referrals of screening-eligible patients remain unacceptably low. We need to better understand clinician knowledge, attitudes, and practice patterns to identify strategies to improve lung cancer screening uptake. Prior studies have focused on understanding these factors from physicians only. Nevertheless, many patients receive primary care from nurse practitioners and physician assistants where prevention and early detection conversations are most likely to occur. Therefore, we must engage the full range of clinicians treating screening-eligible patients. OBJECTIVES: The aim of this study was to describe attitudes, beliefs and referral practice patterns, lung cancer screening knowledge, and concordance with lung cancer screening guidelines among nurse practitioners, physicians, and physician assistants in the United States. METHODS: A descriptive, cross-sectional study was performed using survey methodology with clinical vignettes to examine clinician factors and concordance with U.S. Preventive Services Task Force lung cancer screening guidelines. RESULTS: Participants scored low on attitudes toward shared decision-making, high on the importance of shared decision-making in lung cancer screening, and low on barriers to lung cancer screening referral. In addition, midrange scores on empathy toward patients with smoking history were noted. Lung cancer screening knowledge was low regardless of clinician specialty; the most endorsed response when presented with a hypothetical patient was to refer for lung cancer screening using a chest X-ray. DISCUSSION: Findings demonstrate that most clinicians are nonconcordant with U.S. Preventive Services Task Force guidelines, erroneously believing a chest X-ray is appropriate for lung cancer screening. Clinicians must follow evidence-based practice guidelines, highlighting the need for targeted continuing education about lung cancer screening for clinicians who treat screening-eligible patients.

Development and psychometric evaluation of the Spanish version of the lung cancer screening health belief scale.

OBJECTIVE: The aim of this study was to describe the translation and psychometric testing of the Lung Cancer Screening Health Belief Scale (LCSHBS) into Spanish. METHODS: The English version of the LCSHBS was professionally translated in accordance with best practices in the translation of patient-reported outcome tools. The independent certified professional translator completed a forward translation of the LCSHBS from English to Spanish, followed by a review of the translated questionnaire by a certified Memorial Sloan Kettering Cancer Center Spanish-English bicultural expert, who reviewed the scale for accuracy. RESULTS: Initial testing of the scales is valid and reliable, and supports the Spanish version of the LCSHBS (LCSHBS-S). Internal consistency reliability of the scales was supported with Cronbach's ranging from 0.81 to 0.96. Construct validity was established with confirmatory factor analysis and testing for differences between individuals who have and have not screened in theoretically proposed directions. These newly translated scales can help investigators expand this research into the large Spanish-speaking lung screening-eligible population as they develop and test critical behavioural interventions to increase lung cancer screening in the at-risk population. CONCLUSIONS: Development of effective interventions to enhance shared decision-making about lung cancer screening between patients and providers must first identify factors influencing the individual's screening participation. Future efforts facilitating patient-provider conversations are better informed by understanding the perspective of the individual making the decision.