The Importance of Lay Navigators in Lung Cancer Screening Among Asian Americans in an Integrated Health Care System

Lung cancer is a leading cause of death in Asian Americans, yet prior findings within our health system revealed lung cancer screening rates are low in Asian Americans. This study evaluated the effectiveness of active vs passive outreach in improving lung cancer screening uptake among Asian Americans.

This clinical trial included 1000 Asian Americans who met lung cancer screening eligibility using electronic health records and were assigned to active or passive outreach using stratified random sampling based on age, sex, smoking status, and service area. The active outreach group was contacted about lung cancer screening by a lay navigator. The passive group received outreach about lung cancer screening by email only. Both groups were surveyed and monitored to compare outcomes, including lung cancer screening referral, shared decision-making, and low-dose computed tomography for lung cancer screening.

A total of 997 participants received outreach; 3 died before contact and were excluded from the active outreach group. Outcomes were more prevalent in active vs passive group participants: lung cancer screening referral (25% vs 12%), shared decision-making (16% vs 7%), and low-dose computed tomographic screening (11% vs 4.4%). After adjustment for demographic factors, active (vs passive) group participants were 2.99 times more likely to receive a lung cancer screening referral. Of the 12% of participants who completed the survey, 76% of active group respondents had a favorable view of the lay navigator, and 94% indicated no negatives to being contacted by the navigator.

This novel study demonstrates that lay navigators can increase lung cancer screening uptake in Asian Americans. Future lung cancer screening studies should focus on culturally and linguistically aligned navigators.