BACKGROUND

African American individuals experience disparities in the burden of lung cancer compared to other racial or ethnic groups. Yet, African Americans are less likely than White patients to have provider-initiated discussions about lung cancer screening (LCS). In addition to provider-level barriers, predictors of racial disparities include patient-level knowledge barriers and medical mistrust. This study assessed the feasibility and acceptability of provider- and patient-oriented approaches to increase uptake of LCS in a majority African American primary care clinic setting.

METHODS

In Phase 1, we conducted surveys (N = 22) and usability testing with providers (N = 7) to develop a previsit planning message, a type of clinician reminder. The clinician reminder is sent via the electronic health record ahead of scheduled visits with screening-eligible participants to promote LCS discussion. We partnered with a primary care clinic (N = 5 providers; N = 399 patients 50-80 years old with a documented smoking history, no prior lung cancer diagnosis) to evaluate the impact of the reminder on LCS referral rates. In Phase 2, we conducted a pretest-posttest study (N = 16) to pilot a previsit phone-based patient education session. Patient-level LCS knowledge was assessed using 10 true/false items and a single item measured screening intentions.

RESULTS

In Phase 1, LCS referrals increased from 6 6-months prepilot to 49 during the 6-month pilot period. The majority (89.8%) of the orders placed had a clinician reminder. In Phase 2, from pretest to posttest, there was improvement in LCS knowledge (mean percent correct: 63.3% to 76.7%; P = .013) and screening intentions (43.8% to 82%; P = .05).

CONCLUSIONS

In a diverse clinical setting, we developed a feasible and acceptable multilevel approach aimed at increasing LCS equitably.

CLINICAL TRIAL INFORMATION

The Clinical Trials Registration #NCT04675476.