Investigating Behavior Change Interventions Regarding Lung Screening in the Ambulatory Setting to Improve Lung Health: A Mixed Methodology Study
Principal Investigator: Lauren K. Groner, DO
Lung cancer is the leading cause of cancer-related death in the U.S., and although screening high-risk individuals using low-dose CT (LDCT) has been shown to reduce lung cancer-specific mortality (1, 2), lung cancer screening (LCS) among eligible adults is dismal (~6%). While recent updates to the LCS guidelines will increase the relative percentage of screening-eligible persons by 87%, there remain significant barriers to LCS at the patient, provider, and system levels. Despite ample research identifying barriers to LDCT, few studies have examined effective facilitators to early detection of lung cancer. Hence, we are employing a strategic implementation science approach, using the Behavior Change Wheel (BCW) framework, to design and pilot test a multi-faceted behavior change intervention at the provider level to increase uptake of LDCT screening in urban primary care-based practices with varying resources (NewYork-Presbyterian Medical Group Practices and Community Healthcare Network Long Island City). The specific aims of our study are to: 1) Identify behavioral targets and the most prominent barriers to utilizing LDCT among primary care providers (PCPs) in two different practice model settings using the BCW framework; 2) Determine the most feasible and effective behavior change techniques that address the prioritized; and 3) Pilot a multi-component implementation strategy that will increase LDCT in academic-based faculty practices and FQHCs.
Since receiving the 2022-2023 Health Justice Grant Dalio Center for Health Justice Grant in February, the team has conducted 4 nominal group sessions with primary care providers from around the country to understand physicians’ most prominent barriers to implementing guideline concordant lung cancer screening uptake/referral in their daily practice, particularly regarding minoritized patients. Coding of the data is currently underway and will inform the design of our multicomponent behavior change strategy that will be implemented at our pilot sites from January 2023 through December 2023. Prior to implementation, we will assess the intervention’s feasibility and acceptability using key-informant interviews with a diverse group of stakeholders (providers, administrators, executives, financial experts, and front-desk staff), such that the final multicomponent strategy will be feasible and acceptable in the total context of a primary care practice. The final intervention will be implemented and tested in one NYP (NewYork Presbyterian)- and one FQHC-affiliated primary care practice. The results of this pilot will provide the necessary evidence for a future larger cluster randomized trial testing our multi-faceted implementation strategy to facilitate and enhance the LDCT screening process among diverse populations in diverse clinical and community settings, resulting in a reduction in disparate lung cancer outcomes.