Patient Navigation for Lung Cancer Screening at a Health Care for the Homeless Program: A Randomized Clinical Trial.

Area of Science:

• Public Health
• Health Services Research
• Oncology

Background:

• Individuals experiencing homelessness have more than double the lung cancer mortality rate compared to the general population.
• Lung cancer screening (LCS) using low-dose computed tomography (LDCT) is proven to reduce lung cancer mortality.
• Homelessness presents unique barriers to accessing LCS.

Purpose of the Study:

• To evaluate if patient navigation, in addition to usual care, enhances LCS LDCT completion rates.
• To assess the impact of patient navigation on screening adherence in a Health Care for the Homeless (HCH) setting.

Main Methods:

• A pragmatic, mixed-methods randomized clinical trial was conducted at Boston Health Care for the Homeless Program (BHCHP).
• Eligible participants meeting LCS criteria were randomized (2:1) to usual care with or without patient navigation.
• Patient navigators provided education, facilitated shared decision-making, appointment scheduling, and tobacco cessation support.

Main Results:

• Participants receiving patient navigation had a 4.7-fold higher rate of LCS LDCT completion within 6 months (43.4%) compared to usual care alone (9.2%).
• The study involved 260 participants, with a mean age of 60.5 years.
• Qualitative interviews highlighted the importance of social support, care coordination, and navigator interpersonal skills.

Conclusions:

• Patient navigation support significantly increases one-time LCS LDCT completion among homeless-experienced individuals.
• This intervention demonstrates a successful strategy to overcome barriers to lung cancer screening in vulnerable populations.
• Further research should explore sustained screening participation and long-term outcomes.