Implementing a Tribally Engaged Lung Cancer Screening Pilot Program in Rural Oklahoma

The Tribally Engaged Approaches to Lung Cancer Screening study aimed to codesign and test a community-based lung cancer screening (LCS) program within a large, tribally operated health system. In 2020 to 2021, we conducted a pre-post quasi-experimental pilot implementation study of a tailored and comprehensive LCS program in two Choctaw Nation of Oklahoma primary care clinics in rural Oklahoma. The program included screening quality assessment, academic detailing, practice facilitation, health system enhancements, technology support, centralized LCS coordination, and community outreach. Eligibility for LCS was based on the 2013 U.S. Preventive Services Task Force guidelines. Participants completed pre- and post-intervention surveys on their knowledge, attitudes, and experiences regarding LCS. All participant charts were extracted to determine LCS completion. Postimplementation semi-structured interviews of patients and clinicians were conducted, and practice facilitator notes were analyzed. Participants (N = 57) averaged 67 years, and 66% were current smokers. The proportion of participants who were up-to-date with LCS increased from 39% to 58% (P < 0.01). About 18% of patients reported improvement in general care choice and treatment discussions with their doctor, and about 40% reported an improvement in their awareness or understanding of lung cancer and receipt of LCS. We also identified several key facilitators and barriers to LCS implementation at the practice and health system levels. LCS acceptance and uptake improved significantly in this community-engaged pilot intervention which informed a subsequent cluster-randomized trial. Comprehensive and community-engaged LCS programs may have the potential to improve the delivery of LCS in underserved community settings.

Our community-engaged, multicomponent, and multilevel pilot implementation study significantly improved lung cancer screening rates in a rural, tribal health system. A key feature of this pilot study was a centralized screening coordination service supported by a population screening registry. We believe that our study is replicable in other settings. See related Spotlight, p. 381.