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Improving Lung Cancer Screening at a Safety-Net Hospital: Empowering At-risk Patients Through Self-identification
Christian Ashby-Padial1, Paul Sherban2, Hailey Rich1
1Department of Radiology, Boston Medical Center, 820 Harrison Avenue, 3rd Floor, Boston, MA 02118 (C.A-P., H.R., C.L.); Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts (C.A-P., P.S., H.R., C.L.).
A smoking history questionnaire in radiology waiting areas is feasible for identifying lung cancer screening (LCS) eligibility. However, LCS rates remain low due to various patient and system barriers in safety-net hospitals.
Area of Science:
- Pulmonology
- Radiology
- Public Health
Background:
- Lung cancer screening (LCS) with low-dose computed tomography (LDCT) significantly reduces lung cancer and all-cause mortality.
- Current guidelines recommend LCS for specific high-risk populations based on age and smoking history.
- Screening criteria were updated in 2021 to include more at-risk individuals.
Purpose of the Study:
- To assess the feasibility of a brief, multilingual smoking-history questionnaire in radiology waiting areas.
- To identify patients eligible for LCS in a safety-net hospital setting.
- To evaluate the standardization of LCS eligibility notification to primary care providers (PCPs).
Main Methods:
- A quality improvement initiative was conducted over 18 months (2021-2024).
- A voluntary smoking history questionnaire was administered to patients in radiology waiting areas.
- Data collected included demographics, lung cancer risk, LCS eligibility, and medical/family history.
Main Results:
- A 11.4% response rate was achieved from an estimated 54,000 distributed surveys.
- 6.0% of patients (373) self-identified as eligible for LCS based on USPSTF criteria.
- Only 9.4% of eligible patients, not currently undergoing LCS, had baseline exams ordered after PCP notification.
Conclusions:
- Implementing a smoking-history questionnaire in radiology waiting areas is feasible in safety-net settings.
- Lung cancer screening rates remain low, even with self-identified eligibility and PCP notification.
- Significant patient, provider, and system-level barriers impede LCS uptake in safety-net populations.
