A Multilevel intervention to address health disparities in lung cancer screening

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Abstract Lung cancer is the leading cause of cancer-related mortality in the US, with more than 135,000 deaths expected in 2020. Based on the National Lung Screening Trial, which showed that low-dose computed tomography (lung screening) vs. chest X-ray reduced mortality due to lung cancer by 20%, the US Preventive Services Task Force recommends annual lung screening for asymptomatic high risk individuals. Despite this recommendation, utilization is poor (3%-14%). Lung screening may be particularly beneficial for African Americans (AA), because they are more likely to have advanced disease, lower survival, and lower screening rates compared to whites. The causes of low uptake of lung screening are multifactorial and consistent with evidence from other cancer screening disparities. For example, provider-initiated discussions about cancer screening tests are low overall, and AA and other racial/ethnic minorities are less likely than whites to have these discussions. Another key driver of screening disparities is patients’ lack of knowledge about early detection. Evidence points to the need for multilevel interventions that simultaneously address multiple barriers to increase screening rates and decrease lung cancer morbidity and mortality in minority populations. The proposed study will target two key levels of influence in the healthcare setting: provider and patient behavior in order to address disparities between AA and whites in lung screening awareness and utilization. Guided by NIH’s Health Disparities Research Framework, in the K99 phase, I will receive didactic and mentored training in research methods to address disparities occurring in the healthcare system. I will conduct feasibility studies and formative research to strengthen the content and delivery of the quasi-experimental study (pretest- posttest, with a nonequivalent control group) to be conducted in the R00 phase. The specific aims are to: Aim 1: Evaluate the feasibility and acceptability of implementing a healthcare provider prompt in a primary care network (K99). Aim 2: Develop and pre-test the patient education component (K99). Aim 3: Test the impact of the multilevel intervention on primary (provider-patient communication, screening intentions, and knowledge) and secondary (screening referrals and completion) outcomes (R00). I will explore whether Health Disparities Framework factors (e.g., race, health literacy) moderate these relationships. The proposed multilevel intervention targets important barriers to lung screening that will provide preliminary data to inform a future R01 application designed to measure the independent and overlapping contributions of the provider and patient interventions. This award, along with the institutional environment, training, research resources, and mentoring team available to me through the Georgetown Lombardi Comprehensive Cancer Center, will provide the necessary training to develop approaches to reduce disparities that arise in the clinical setting and will launch my career as an independent cancer control scientist focused on eliminating cancer disparities.