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.

Inclusion Criteria:

- Patients referred for lung cancer screening using a low-dose CT scan modality who are
considered high risk by USPSTF guidelines.

- Patients who speak English or Spanish

Exclusion Criteria:

- Patients who do not speak English or Spanish

- Patients who are or become ineligible as defined by USPSTF guidelines for lung cancer
screening.