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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.).
Rationale And Objectives:
Lung cancer screening (LCS) with low-dose computed tomography (LDCT) reduces lung cancer mortality by 20% and all-cause mortality by 6.7%. In 2013, the United States Preventive Services Task Force (USPSTF) recommended LCS with LDCT for adults aged 55-80 with a ≥30 pack-year smoking history who currently smoke or quit within the past 15 years. In 2021, these recommendations grew to include more at-risk populations by lowering the screening age to 50 years and reducing the smoking history threshold to 20 pack-years. We assessed the feasibility of a brief, multilingual smoking-history questionnaire in radiology waiting areas to identify LCS eligibility and standardize notification to primary care providers (PCPs) in a safety-net hospital.
Materials And Methods:
Quality improvement initiative, exempt from formal IRB review and the requirement for informed consent. Over an 18-month period between 2021 and 2024, we administered a voluntary smoking history questionnaire assessing demographics, lung cancer risk, LCS eligibility, and relevant medical and family history to all patients arriving for imaging appointments.
Results:
From an estimated total of 54,000 surveys distributed, 6160 questionnaires were collected (11.4% response rate), and 373 patients (6.0%) self-identified as eligible for LCS based on either 2013 or 2021 USPSTF criteria. Among these patients, 202 (54.2%) were not currently undergoing LCS. Following PCP notification of their patients' LCS eligibility, only 19 of the 202 patients (9.4%) subsequently had baseline LCS exams ordered. These proportions reflect feasibility/process and are not evidence of effectiveness.
Conclusion:
A brief, multilingual smoking-history questionnaire in radiology waiting areas in a safety-net setting was feasible to implement. LCS rates remain low despite patient self-identification of LCS eligibility and PCP notification. This low uptake highlights the challenges of LCS and may reflect patient, healthcare provider, and systems-level barriers faced by patients in safety-net hospitals, such as financial constraints and limited healthcare access.
