Determinants of lung cancer screening follow-up care in community care settings: A qualitative multi-case study in the ACCELL trial.

BACKGROUND

Adherence to lung cancer screening (LCS) follow-up is essential to achieve mortality benefits from screening. However, population-based studies demonstrate follow-up is <50% in clinical settings. Determinants (barriers and facilitators) of LCS follow-up in community settings are under-studied.

RESEARCH QUESTION: What are determinants of LCS follow-up in community settings?

STUDY DESIGN AND

METHODS

This qualitative multi-case study informed a pre-post intervention trial, testing pragmatic interventions to address LCS follow-up in community settings. We conducted rapid ethnographic assessments (REA) through virtual and in person site visits of LCS delivery in three community-based healthcare systems in Washington state. Additionally at the two future intervention sites, we conducted provider and patient interviews. Interview transcripts were analyzed using Rapid Group Analysis Process. All data were triangulated according to Consolidated Framework for Implementation Research and National Institute on Minority Health and Health Disparities Research Framework domains.

RESULTS

Twenty-eight organizational leaders, providers, and staff participated in REA. Thirty-one patients and 15 providers from the future intervention sites participated in interviews. Determinants of LCS follow-up in the intervention domain included role of primary care, LCS complexity and care process standardization. In the inner setting domain (organization and clinic), screening prioritization, EHR use, radiology support, and context of wellness visits affected LCS. The main theme in the outer setting domain was the influence of social determinants of health on LCS. In the individuals domain, shared beliefs in LCS and LCS education and information sharing were key. In the process implementation domain, clinical champions and use of data and metrics were crucial.

INTERPRETATION: Integrated findings suggest determinants related to LCS complexity, care fragmentation, socioeconomic status and language, and limitations of PCPs could be overcome through more centralized approaches. However, increased use of EHR tools, increased education and standardizing LCS performance metrics may enable follow-up in decentralized settings.

CLINICAL TRIALS REGISTRATION: NCT06324110.