Planning Funding and Outcomes, Waitematā District, Te Whatu Ora and Te Toka Tumai Auckland District, Te Whatu Ora, Auckland, New Zealand.
Ngāi Tahu Māori Health Research Unit, School of Health Sciences, University of Otago, Dunedin, New Zealand.
PLoS One. 2023 Aug 1;18(8):e0281420. doi: 10.1371/journal.pone.0281420. eCollection 2023.
Lung cancer screening can significantly reduce mortality from lung cancer. Further evidence about how to optimize lung cancer screening for specific populations, including Aotearoa New Zealand (NZ)'s Indigenous Māori (who experience disproportionately higher rates of lung cancer), is needed to ensure it is equitable. This community-based, pragmatic cluster randomized trial aims to determine whether a lung cancer screening invitation from a patient's primary care physician, compared to from a centralized screening service, will optimize screening uptake for Māori. Participating primary care practices (clinics) in Auckland, Aotearoa NZ will be randomized to either the primary care-led or centralized service for delivery of the screening invitation. Clinic patients who meet the following criteria will be eligible: Māori; aged 55-74 years; enrolled in participating clinics in the region; ever-smokers; and have at least a 2% risk of developing lung cancer within six years (determined using the PLCOM2012 risk prediction model). Eligible patients who respond positively to the invitation will undertake shared decision-making with a nurse about undergoing a low dose CT scan (LDCT) and an assessment for Chronic Obstructive Pulmonary Disease (COPD). The primary outcomes are: 1) the proportion of eligible population who complete a risk assessment and 2) the proportion of people eligible for a CT scan who complete the CT scan. Secondary outcomes include evaluating the contextual factors needed to inform the screening process, such as including assessment for Chronic Obstructive Pulmonary Disease (COPD). We will also use the RE-AIM framework to evaluate specific implementation factors. This study is a world-first, Indigenous-led lung cancer screening trial for Māori participants. The study will provide policy-relevant information on a key policy parameter, invitation method. In addition, the trial includes a nested analysis of COPD in the screened Indigenous population, and it provides baseline (T0 screen round) data using RE-AIM implementation outcomes.
肺癌筛查可显著降低肺癌死亡率。需要进一步的证据来优化针对特定人群的肺癌筛查，包括新西兰的毛利人（其肺癌发病率不成比例地更高），以确保其公平性。这项基于社区的、务实的聚类随机试验旨在确定与来自集中筛查服务的邀请相比，患者的初级保健医生发出的肺癌筛查邀请是否会优化毛利人的筛查参与率。新西兰奥克兰的参与初级保健实践（诊所）将被随机分配到以初级保健为主导的或集中服务来提供筛查邀请。符合以下标准的诊所患者将有资格参加：毛利人；年龄在 55-74 岁之间；在该地区参与诊所注册；曾经吸烟者；并且在未来六年内有至少 2%的患肺癌风险（使用 PLCOM2012 风险预测模型确定）。对邀请做出积极响应的合格患者将与护士一起进行关于接受低剂量 CT 扫描（LDCT）和慢性阻塞性肺疾病（COPD）评估的共同决策。主要结果是：1）完成风险评估的合格人群比例和 2）有资格进行 CT 扫描的人完成 CT 扫描的比例。次要结果包括评估为告知筛选过程所需的背景因素，例如包括对慢性阻塞性肺疾病（COPD）的评估。我们还将使用 RE-AIM 框架评估特定的实施因素。这是一项针对毛利人参与者的开创性的、由土著人领导的肺癌筛查试验。该研究将为关键政策参数——邀请方法提供与政策相关的信息。此外，该试验包括在筛查的土著人群中对 COPD 的嵌套分析，并且它提供了使用 RE-AIM 实施结果的基线（T0 筛查轮）数据。
