Improving Racial Disparities in Lung Cancer Screening Uptake: A Mixed-Methods Study of a Centralized Program

Lung cancer screening (LCS) uptake remains inequitable across the United States, especially among individuals who identify as Black or African American. Synthesized and integrated analyses of quantitative and qualitative studies provide a more thorough understanding of complex facilitators and barriers to LCS uptake among Black veterans.

An explanatory sequential mixed-methods design was used to conduct 1 quantitative and 2 qualitative studies at the Durham Veterans Affairs Healthcare System. Quantitative data from a cross-sectional study of Black and White veterans referred for LCS between July 2013 and August 2021 were integrated with thematic analyses of semistructured interviews with Black veteran patients, primary care providers, and LCS program staff. A content analysis of barriers and facilitators to LCS was guided by Fetters' assessment of coherence to determine the fit of data integration.

We integrated data from 4,562 veteran patient electronic health record charts, 32 veteran patient interviews, and 20 health care provider interviews. Areas of confirmation included motivation for screening, patient characteristics and social networks, shared decision-making, and multistep processes for LCS. Areas of discordance included perceived risk, patient-provider trust, rurality, and transportation. Finally, areas of expansion included competing priorities and race, racism, and structural inequities.

This study highlights critical areas influencing LCS uptake among Black veterans, as well as where veteran and provider perceptions align-and diverge-from quantitative screening data. The findings underscore the need for implementation strategies that address both individual-level and structural changes to ensure equity in LCS uptake.