Abstract 3312: Appropriate follow-up for patients with suspicious lung cancer screening findings: Lessons learned from Federally Qualified Health Centers
Authors: Watson Lesley , Cotter Megan M. , Smith Robert A. , Sharpe Katherine 
Published: August 2019

Abstract
Background: Low-dose CT (LDCT) lung cancer screening is associated with improved outcomes in high-risk adults, but uptake remains low and such medical advances are often not available in low-resource areas. The American Cancer Society (ACS) launched a pilot program focused on establishing effective processes to refer and screen patients for lung cancer in under-resourced areas in West Virginia and Tennessee. ACS partnered with two Federally Qualified Health Centers (FQHCs) and accredited screening facilities to refer and screen patients, and to identify critical facilitators, barriers, and lessons learned in implementing LDCT and moving patients through the screening continuum.
Methods: Annual site visits in 2017 and 2018 captured data on implementation, progress, and lessons learned. ACS evaluators conducted 47 key informant interviews with staff from both study sites, including navigators, clinical staff, and administrators. Interviews were recorded and transcribed verbatim. Evaluators used transcripts and project notes to conduct a thematic analysis to assess factors associated with effective implementation and improved outcomes.
Results: Participants shared a wealth of insight on program implementation, including lessons learned about forming successful partnerships, personnel and resource requirements, determining screening eligibility, and conducting shared decision-making. One key area where site teams had to overcome implementation challenges was in determining appropriate follow-up testing for patients with suspicious or borderline suspicious findings (L-RADS 3 or 4). Some referring primary care providers were confused by existing clinical guidelines, unsure of when to order LDCT versus chest-CT, and felt ill-equipped to determine the optimal follow-up tests. There was confusion about the difference between billing follow-up exams as “screening” versus “diagnostic.” Program leaders investigated these and other matters and came to consensus on the most practical, logical solutions. One study site also initiated a lung nodule team to discuss suspicious findings in-depth. This practice allowed the team to review clinical history and gain consensus around appropriate diagnostic testing for individual patients, and its implementation went well enough for the team to recommend it to ACS as a potential best practice for future programs.
Conclusions: By identifying challenges in conducting follow-up testing after LDCT and successful means of overcoming these challenges, this pilot study can inform practitioners in means of overcoming challenges that may enable underserved populations to move successfully through the lung cancer screening continuum. In so doing, this study may promote further reduction in cancer health disparities.
Citation Format: Lesley Watson, Megan M. Cotter, Robert A. Smith, Katherine Sharpe. Appropriate follow-up for patients with suspicious lung cancer screening findings: Lessons learned from Federally Qualified Health Centers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3312.