Hospitalization as an opportunity to engage underserved individuals in shared decision-making for lung cancer screening: results from two randomized pilot trials

• Published in: Cancer causes & control Vol. 33; no. 11; pp. 1373 - 1380
• Main Authors: Kathuria, Hasmeena, Gunawan, Adrian, Spring, Matthew, Aijaz, Sara, Cobb, Vinson, Fitzgerald, Carmel, Wakeman, Cornelia, Howard, Jinesa, Clancy, Mary, Foreman, Alexis Gallardo, Truong, Ve, Wong, Carolina, Steiling, Katrina, Lasser, Karen E., Bulekova, Katia, Wiener, Renda Soylemez
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-11-2022; Springer Nature B.V
• Subjects: Assessments; Biomedical and Life Sciences; Biomedicine; Brief Report; Cancer Research; Cancer screening; Chest; Clinical decision making; Clinical trials; Comparators; Computed tomography; Decision making; Diagnostic systems; Effectiveness; Epidemiology; Feasibility; Government programs; Health care; Hematology; Lung cancer; Medical personnel; Medical screening; Oncology; Patients; Primary care; Public Health; Qualitative analysis; Tobacco; Safety-net hospital; Community health worker (CHW) navigation; Nurse practitioner; Shared decision-making (SDM); Lung cancer screening (LCS)
• ISSN: 0957-5243; 1573-7225
• DOI: 10.1007/s10552-022-01620-8

Purpose
Medicare requires tobacco dependence counseling and shared decision-making (SDM) for lung cancer screening (LCS) reimbursement. We hypothesized that initiating SDM during inpatient tobacco treatment visits would increase LCS among patients with barriers to proactively seeking outpatient preventive care.
Methods
We collected baseline assessments and performed two pilot randomized trials at our safety-net hospital. Pilot 1 tested feasibility, acceptability, and preliminary efficacy of a nurse practitioner initiating SDM for LCS during hospitalization (
Inpatient SDM
). We collected qualitative data on barriers encountered during Pilot 1. Pilot 2 added a community health worker (CHW) to address barriers to LCS completion (
Inpatient SDM
 + 
CHW-navigation
). For both studies, preliminary efficacy was an intention-to-treat analysis of LCS completion at 3 months between intervention and comparator (furnishing of LCS decision aid only) groups.
Results
Baseline assessments showed that patients preferred in-person LCS discussions versus self-reviewing materials; overall 20% had difficulty understanding written information. In Pilot 1, 4% (2/52) in
Inpatient SDM
versus 2% (1/48, comparator) completed LCS (
p
 = 0.6), despite 89% (89/100) desiring LCS. Primary care providers noted that competing priorities and patient factors (e.g., social barriers to keeping appointments) prevented the intervention from working as intended. In Pilot 2, 50% (5/10) in
Inpatient SDM
 + 
CHW-navigation
versus 9% (1/11, comparator) completed LCS (
p
 < 0.05). Many patients were ineligible due to recent diagnostic chest CT (Pilot 1: 255/659; Pilot 2: 239/527).
Conclusions
Inpatient SDM
 + 
CHW-navigation
shows promise to improve LCS rates among underserved patients who smoke, but feasibility is limited by recent diagnostic chest CT among inpatients. Implementing CHW-navigation in other clinical settings may facilitate LCS for underserved patients.
Trail registration
ClinicalTrials.gov Identifier: NCT03276806 (8 September 2017); NCT03793894 (4 January 2019).