Context: Lung cancer is the leading cause of cancer mortality among American Indians and Alaska Natives (AI/AN), and AI/AN have worse lung cancer incidence rates, survival, and death compared to the general population. Although lung cancer screening (LCS) with low-dose computed tomography is a grade-B USPSTF recommendation, uptake of LCS has been slow in most healthcare systems. LCS implementation among AI/AN has not been studied before in detail.
Objective: To address this knowledge and implementation gap, we initiated the 5-year “Tribally Engaged Approaches to Lung Screening" (TEALS) study in 2019 to co-design and test a tribal community-engaged LCS implementation program.
Setting: TEALS is being conducted in 8 primary care centers of the Choctaw Nation Health Services Authority (CNHSA) in Southeast Oklahoma using a Community-Engaged Research (CEnR) approach.
Study Design: Year-1: Planning and program co-development; Year-2: Pilot implementation study in 2 CNHSA centers; Year-3-4: Pair-matched, cluster implementation RCT in 6 centers; Year-5: Dissemination.
Population Studied: AI patients (N=580), who meet LCS criteria and clinicians/staff/leadership (N~50) from all CNHSA primary care centers.
Intervention: Control (delayed intervention) practices will receive usual EHR reminders for LCS and access to existing LCS services, smoking cessation, and lung cancer treatment. Intervention practices will also receive additional system improvements, including an LCS Care Coordinator, quality benchmarking and feedback, academic detailing, practice facilitation, learning collaboratives, and technical support.
Outcomes: One to two-year changes in LCS care pathways and care delivery (primary), patient morbidity profile and care experiences (secondary/patient-level), and practice LCS care system improvements (secondary/practice-level).
Results: By the end of Year-1, our team has assembled a multidisciplinary study team, built relationships, created and received guidance from a community advisory board, mapped existing LCS processes, designed a community-specific shared decision aid, collected pre-intervention qualitative data, and designed the Year-2 pilot study.
Future Steps: Post-COVID-19 continuation of TEALS with Year-2 pilot activities and preparing for the RCT in Years 3-4.