VA-CEDAR Tool for Equity in Lung Cancer Screening
Neelima Navuluri, MD, MPH
Durham VA Medical Center
Durham
The veteran population is disproportionately affected by lung cancer and relatively few patients that are eligible participate in lung cancer screening. This low participation is due to barriers such as provider bias, structural racism, patient mistrust, and fear of diagnosis. In this project, Dr. Navuluri proposes to develop and test an electronic shared decision-making aid and referral tool to improve equity in lung cancer screening (LCS). She will pilot test the aid to assess its feasibility and usability among patients and providers within the Durham VA system.
Research Summary
Lung cancer is the most common cause of cancer death in the United States and Veterans are disproportionately affected. Lung cancer screening (LCS) provides an important opportunity to better diagnose and treat lung cancer, thus reducing the number of deaths among high risk patients. However, relatively few patients participate in LCS programs such as the one offered by the Durham Veterans Affairs Healthcare System and participation rates among communities of color are especially low. This low LCS participation is in part to due to barriers related to shared decision making, or the process in which providers and the patient share knowledge about the individualized risks and benefits of LCS. These barriers may include fear of cancer diagnosis, patient mistrust, structural racism, and provider biases. The goal of our study is to develop an intervention centered on shared decision making that improves equity in LCS decision making and participation. We will obtain and incorporate direct input from a diverse group of Veterans, providers, and community advisory board members to develop and refine and electronic shared decision aid and referral tool to aid Veterans and providers in engaging in shared-decision making regarding LCS. The tool will also facilitate streamlined low- dose CT orders for eligible and interested Veterans. We will also test this tool among real patients and providers at the Durham VA.
Technical Abstract
Lung cancer is the most common cause of cancer mortality in the United States and Veterans are disproportionately affected. Lung cancer screening (LCS) using annual low-dose computed tomography (CT) scans substantially reduces lung cancer mortality by nearly one-quarter. Yet, uptake of LCS within the Durham Veterans Affairs Healthcare System is low as compared to other cancer screening programs, with participation rates among Black Veterans, Veterans from rural areas, and Veterans with mental health comorbidities being especially low. Barriers and facilitators to LCS include fear of cancer diagnosis, patient mistrust, structural racism, and provider biases, all of which impact shared-decision making around LCS. This study aims to develop an intervention using human centered design and community-based participatory research methodologies which can potentially improve equity in LCS shared decision making, referral, and participation and then pilot test the intervention to assess its feasibility, acceptability and usability. We hypothesize that the intervention will take the form of an electronic-shared decision aid and referral tool which will facilitate streamlined CT orders for eligible and interested Veterans and that it will be feasible, acceptable, and usable among both Veterans and VA providers.
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