Clinical low-dose CT (LDCT) screening programs throughout the nation have struggled in recent years to significantly increase screening utilization. What can be done to finally reverse this trend?
Author Christopher Lee, MD, department of radiology at Keck Hospital of USC in Los Angeles, spent the last few years helping develop and implement a lung cancer screening program in Los Angeles County, writing about his experience in the American Journal of Roentgenology. He shared numerous strategies for improving participation in such programs, including:
1. Identify partners within the community
Without gaining the trust of individuals in a community, it can be quite difficult to recruit anyone to be screened for lung cancer. Lee explained that one of the first steps he and his colleagues took was working to identify “community partners” who can recommend screening to residents and educate the public about both lung cancer and early detection.
“Our institution is more than 15 miles from south Los Angeles and does not have a significant footprint within these neighborhoods,” Lee wrote. “Moreover, we were concerned that residents would be distrustful of an academic medical center's apparent sudden interest in their health and well-being. As a result, we identified and partnered with a large community health center within the Centinela Valley that has developed trust from the community over many years of service. During our initial meetings with the health center, we educated the staff and clinicians on the rationale for lung cancer screening, as well as the elements that should be discussed during a shared decision-making visit.”
2. Provide transportation assistance
Lee and his team recognized that their medical center’s location—15 miles from south Los Angeles—wasn’t exactly convenient for many of the residents they were hoping to recruit into their program. Even taking a bus was risky, he explained, because it didn’t drop people right in front of the imaging center, creating a risk that they could get lost along the way.
The solution to this dilemma? Uber, the taxi service found in cities throughout the country.
“We offer free Uber rides to and from the medical center for those patients who do not have a reliable means of transportation,” Lee wrote. “Our screening coordinator arranges the Uber and meets the patient at the curbside when the car arrives. To date, more than 90 percent of our patients have taken advantage of the Uber service; many have expressed that this free door-to-door service is one of the nicest perks of the program.”
This does provide “a financial burden” on facilities, Lee added, but he says it is worth the additional costs to remove such a significant barrier to community-based screening.
3. Communicate suspicious findings in a helpful, personal manner
The team behind the screening program included a “patient navigator” who would communicate suspicious LDCT findings to both patients and the patient’s primary care physician. Patients often can’t actually undergo further evaluation at the team’s medical center due to their insurance status, Lee explained, but the patient navigator does go through every step of that process with the patients to help them figure out what they need to do next.
“In addition, the navigator frequently needs to address other issues that prevent the patient from seeking appropriate follow-up care, including financial and housing concerns, transportation, mental health issues, and substance abuse,” Lee wrote. “The availability of such personalized and dedicated navigation has been met with extreme gratitude by both the patients and our community partners and is, undoubtedly, a major reason our lung cancer screening program has been welcomed into their communities.”