Systemic Challenges to Lung Cancer Screening in the Safety-Net Setting: Care and Informatics Fragmentation.

Area of Science:

• Health Services Research
• Health Equity
• Cancer Screening Programs

Background:

• Lung cancer screening rates remain low (<20%) in eligible Americans, despite being the leading cause of cancer death.
• Lower-income and Medicaid-insured populations face the greatest lung cancer risk but have the lowest screening rates.
• Understanding systemic challenges in safety-net settings is crucial for improving lung cancer screening and care delivery.

Purpose of the Study:

• To investigate systemic challenges in safety-net organizations that impact the complete episode of care for imaging-based cancer screening.
• To identify barriers to multidisciplinary care coordination from screening to treatment in resource-limited environments.

Main Methods:

• A qualitative case study design was employed, focusing on purposively sampled safety-net organizations in Los Angeles County.
• Semi-structured telephone interviews were conducted with screening experts to explore their organizations' imaging-based screening pipelines.
• Inductive thematic analysis was used to analyze transcribed interview data.

Main Results:

• Two primary systemic challenges were identified: fragmentation of care across organizations and siloed health information, especially imaging data.
• These challenges prevent process simplification and automation, leading to manual, labor-intensive workarounds.
• Fragmentation impacts established screening programs, not just newer ones.

Conclusions:

• Fragmentation of care and health informatics significantly deplete safety-net resources, making cancer screening programs labor-intensive.
• Effective, equitable screening solutions must address these systemic issues comprehensively and extend beyond individual organizational boundaries.
• Addressing these barriers is essential for improving cancer screening equity and outcomes in vulnerable populations.