A mixed-methods evaluation of a patient navigation intervention to support lung cancer prevention in LGBTQ+ adults

The lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) community represents a high-risk group for lung cancer given higher smoking rates. We evaluated implementation of a pilot patient navigation intervention for smoking cessation services combined with lung cancer screening (LCS) care for eligible LGBTQ+ adults.

We completed a concurrent mixed-methods evaluation of the intervention to enhance adaptation and future scale. Forty-one LGBTQ+-identifying individuals who were eligible for LCS and currently smoking were enrolled, completed baseline surveys, and underwent the intervention for a 90-day period. Thirty-four participants completed post-intervention surveys and 15 were invited for semi-structured interviews. We conducted a thematic analysis of qualitative data, integrated with quantitative and qualitative survey data through joint displays, guided by the Health Equity Implementation Framework.

We identified fourteen themes in three topical domains. Key themes related to Intervention Success included: flexible communication; iterative contact through a longitudinal relationship; improved confidence and comfort; multimodal and tailored elements. Themes related specifically to LGBTQ+ Care included: LGBTQ+-specific social challenges; the impact of historic discrimination; emphasis on non-judgmental care; and varied responses to LGBTQ+-specific tailoring. Themes related to Future Adaptations included: more education and information on the LGBTQ+-tailored approach; synergy with trusted primary care clinicians; upfront information on financial risks; community connection and peer support; and variable need for more intense support.

LGBTQ+-tailored patient navigation is an acceptable and well-suited intervention to facilitate and integrate LCS care and smoking cessation. Further adaptation should include more education and incorporate components of community support.