Abstract PO-067: Developing provider education to address barriers and reduce disparities in lung cancer screening and smoking cessation treatment among underserved patients
Authors: Smith Laney , Dunlap Daisy , Williams Randi , Shepherd Andrea , Windels Allison , Geronimo Maria , Parikh Vicky , Breece Chavalia J. , Puran Namita , Anderson Eric , Adams-Campbell Lucile , Taylor Kathryn 
Published: January 2022

Abstract
Introduction: Lung cancer is a major public health problem in the US and disparities exist in lung cancer burden and lung cancer screening (LCS) utilization. African Americans (AA) have the highest lung cancer incidence and mortality compared to other racial and ethnic groups; however, LCS rates were lower among AAs compared to Whites under the 2013 United States Preventive Services Task Force (USPSTF) guidelines. While the expanded 2021 USPSTF criteria will significantly raise the number of AAs eligible for LCS, methods to increase rates of LCS among AA patients will still be needed. We describe the development of the first provider educational tool that focuses on barriers to reduce disparities in LCS. Methods: We completed qualitative interviews with primary care providers (N=9) and AA patients eligible for LCS (N=8; 4 screened, 4 unscreened) to assess barriers to LCS and tobacco cessation. Interviews were recorded and analyzed for common themes, which led to the development of the provider intervention. Results: Among patients, common barriers to LCS were a lack of information on the LCS procedure and associated costs, fear of the results, and transportation issues. Patient barriers to utilization of evidence-based cessation treatments included tobacco use stigma, cost of cessation aids, and inconsistent provider communication. Providers acknowledged time constraints during patient visits, lack of standardized training on documenting tobacco use, and the required LCS shared-decision making conversation as barriers to providing LCS referrals and cessation treatment. Both providers and patients noted that LCS rates may be increased by providing patient-facing information on the screening process and by facilitating provider referrals, which are essential for LCS. Based on these findings, we developed a self-directed 30-minute e-learning Health Disparities module that addresses: 1) disparities in the burden of lung cancer; 2) disparities in smoking patterns and utilization of evidence-based smoking cessation treatments; 3) patient barriers to LCS; and 4) resources for providers to address common LCS barriers (e.g., patient reminders to support scheduling the scan, offering transportation options). Experts in health disparities (N=6) and LCS (N=9) provided detailed critiques of the module content and presentation. Conclusions: We identified barriers to LCS and tobacco cessation from the perspectives of providers and AA patients. These findings informed the development of a brief web-based provider educational module to raise awareness about lung cancer and tobacco-related disparities and to provide resources to reduce barriers in diverse patient populations. We have begun a RCT to compare the Health Disparities module to an existing provider module on LCS to evaluate the impact on primary care providers' knowledge, attitudes, and LCS referrals of AA and White patients. These findings will provide preliminary evidence on provider education that can be easily disseminated to address health disparities in LCS and smoking cessation treatments.
Citation Format: Laney Smith, Daisy Dunlap, Randi Williams, Andrea Shepherd, Allison Windels, Maria Geronimo, Vicky Parikh, Chavalia J. Breece, Namita Puran, Eric Anderson, Lucile Adams-Campbell, Kathryn Taylor. Developing provider education to address barriers and reduce disparities in lung cancer screening and smoking cessation treatment among underserved patients [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-067.