Department of Radiology and Officer of Radiology, Community, and Health Equity, Massachusetts General Hospital, Boston, Massachusetts; Assistant Professor, Department of Radiology, Harvard Medical School, Boston, Massachusetts; The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts.
The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts; Assistant Professor, Department of Family and Preventive Medicine, TSET Health Promotion Center, and Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
J Am Coll Radiol. 2021 Dec;18(12):1624-1634. doi: 10.1016/j.jacr.2021.07.010. Epub 2021 Aug 7.
Individuals with serious mental illness (SMI) experience disparities in lung cancer mortality. Using a two-phase, mixed-methods approach, we developed a person-centered lung cancer screening (LCS) educational intervention (phase 1) for individuals with SMI (schizophrenia and bipolar disorder) and evaluated acceptability, feasibility, and changes in attitudes toward LCS (phase 2).
Phase 1: We conducted three focus groups with mental health, primary care, and radiology clinicians and utilized rapid qualitative analysis to adapt the LCS intervention (LCS walk-through video and smoking cessation handouts) tailored for individuals with SMI. Phase 2: We enrolled LCS-eligible patients with SMI (n = 15) and assessed the feasibility (>50% enrollment; >75% completion) and acceptability (>75% overall satisfaction) of an LCS educational intervention delivered by a radiologist and a mental health clinician at a community mental health clinic. We explored changes in participant attitudes about lung cancer, LCS, and smoking before and after the intervention.
Phase 1: Focus groups with primary care (n = 5), radiologists (n = 9), and mental health clinicians (n = 6) recommended person-centered language and adapting a video demonstrating the process of LCS to address concerns specific to SMI, including paranoia and concrete thinking. Phase 2: Fifty percent (15 of 30) of eligible patients enrolled in the LCS intervention, 100% (15 of 15) completed the intervention, and 93% (14 of 15) were satisfied with the intervention. Participants reported a significantly greater worry about developing lung cancer postintervention, but there were no other significant differences.
Radiologists can partner with primary care and community mental health clinics to lead equity efforts in LCS among individuals with SMI.
患有严重精神疾病（SMI）的个体在肺癌死亡率方面存在差异。我们采用两阶段、混合方法，为 SMI（精神分裂症和双相情感障碍）患者开发了一种以患者为中心的肺癌筛查（LCS）教育干预措施（第 1 阶段），并评估了其可接受性、可行性以及对 LCS 的态度变化（第 2 阶段）。
第 1 阶段：我们与精神卫生、初级保健和放射科临床医生进行了三次焦点小组讨论，并利用快速定性分析，根据 SMI 患者的需求调整了 LCS 干预措施（LCS 演练视频和戒烟传单）。第 2 阶段：我们招募了符合 LCS 条件的 SMI 患者（n=15），评估了在社区心理健康诊所由放射科医生和心理健康临床医生提供 LCS 教育干预措施的可行性（>50%的入组率；>75%的完成率）和可接受性（>75%的总体满意度）。我们探讨了干预前后参与者对肺癌、LCS 和吸烟的态度变化。
第 1 阶段：初级保健组（n=5）、放射科医生组（n=9）和精神卫生临床医生组（n=6）的焦点小组建议使用以患者为中心的语言，并调整演示 LCS 过程的视频，以解决与 SMI 相关的具体问题，包括妄想和具体思维。第 2 阶段：50%（15/30）符合条件的患者入组 LCS 干预措施，100%（15/15）完成干预措施，93%（15/15）对干预措施表示满意。参与者报告说，干预后对患肺癌的担忧明显增加，但没有其他显著差异。
放射科医生可以与初级保健和社区心理健康诊所合作，在 SMI 患者中开展 LCS 公平性工作。
