Understanding Rural Patient, and Provider Preferences for Mobile Lung Cancer Screening Clinics

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PROJECT SUMMARY/ABSTRACT Project 1 (Hasson): Understanding Rural Patient and Provider Preferences for Mobile Lung Cancer Screening Clinics Despite the fact that outcomes are best when treatment is given in the early stages of lung cancer, less than 6% of eligible high-risk patients participate in lung cancer screening (LCS), with even lower participation in rural populations. Data from the National Lung Screening Trial (NLST), a multi-institutional randomized controlled study of over 50,000 patients, demonstrated the utility of LCS by comparing low-dose computed tomography (CT) with chest X-ray. It found that LCS with low-dose CT was associated with a 20% reduction in lung cancer-specific mortality, as well as an overall mortality reduction of 6.7%. Many organizations have subsequently published guidelines supporting annual LCS. Nevertheless, 10 years later, despite multiple studies confirming the results of the NLST, and revised guidelines based on continued research into its efficacy, low-dose CT is still underutilized, and a disproportionate number of high-risk patients are either not referred or do not undergo screening. While the reasons for this are multifactorial, the need to better understand the current rural screening landscape, and rural provider and patient barriers leading to low participation, is imperative to resolve this public health dilemma. Additionally, given these hard-to-reach locations, use of a community-based approach is vital to developing an intervention that would be well-utilized. The primary objectives of this proposed study are to identify provider and patient barriers and facilitators that predict referral to, and utilization of, LCS in rural spaces; assess feasibility and acceptability of mobile clinics for screening; and test a mobile unit intervention. The proposed approach used to deliver LCS was designed to reduce logistical and psychosocial barriers. In rural areas, a mobile unit should be feasible and acceptable to patients and providers, and may serve to supplement traditional hospital or clinic-based screening. Based on the success of mobile breast and cervical cancer screening programs, the research team seeks to determine whether a mobile unit will be more successful in increasing screening in rural areas than a traditional hospital- based approach. This project will develop this hypothesis by: (1) identifying regions with high rates of lung cancer (and lung cancer identified at later stages); (2) obtaining input from community members to inform a feasible, acceptable mobile LCS intervention; and then (3) pilot testing a mobile LCS clinic. Findings from this study will aid in the development of a scalable, feasible intervention acceptable to patients and providers in rural areas to improve LCS. Further, by understanding the needs of rural communities and enhancing opportunities for LCS closer to home, earlier detection, prompter treatment, and improved cancer outcomes can be achieved.