Patient Navigation for Lung Cancer Screening in an Urban Safety-Net System

Widespread implementation of CT-based lung cancer screening is underway, but its impact

on cancer morbidity and mortality can only be achieved IF people are screened at

appropriate intervals and abnormal findings are appropriately assessed. The degree to

which individuals, especially those from medically underserved populations with highest

lung cancer risks, will adhere to the complex, multi-step process of CT-based lung cancer

screening has emerged as a key question with immediate need for solution. Specific aims

of the study are as follows:

- Aim 1: Compare rates of completion for clinically recommended steps in the lung

cancer screening process between patients referred for CT-based lung cancer

screening who are randomized to the navigation intervention versus patients who

receive usual care.

- Aim 2: Compare changes in patient-reported outcomes, including satisfaction with

care, psychosocial distress, and tobacco use between patients in the navigation

intervention versus those who receive usual care for the CT-based lung cancer

screening process.

- Aim 3 (Exploratory): Explore whether differences seen in Aims 1 and 2 are moderated

theory-based patient attitudes and beliefs (perceived susceptibility, severity of

lung cancer, perceived benefits/barriers to screening, self-efficacy).

This study will offer unprecedented insight into implementation of lung cancer screening

for high-risk individuals in underserved settings. Findings will show whether navigation

interventions increase adherence to the screening process and affect patient-reported

outcomes among underserved populations. The proposed program aims to address these issues

for lung cancer screening at its inception, rather than after disparities in screening

uptake have already emerged.