The Hispanic/Latinx community (hereafter Hispanic) is the country's second-largest racial/ethnic group, accounting for 19.1% of the total population. However, they remain one of the most underserved populations with suboptimal access to healthcare and screening services due to low income, lack of health insurance, perceived discrimination, language barriers, and limited health literacy. Lung cancer is the leading cause of cancer related mortality with 1.8 million annual deaths worldwide, with Hispanic patients known to have lower survival rates compared with non-Hispanic whites. Lung cancer screening (LCS) with low dose computed tomography (LDCT) decreases this mortality rate of lung cancer by 20%. Yet many Latinx patients who are eligible for lung cancer screening are still falling through the cracks which prevents patients the ability to detect lung cancer early. This study will test and compare the effect of a multi-level intervention on ordering LDCT within 4 months after patient enrollment to those in an Enhanced Usual Care. Our proposed intervention includes: * Primary care provider notifications of patients' LCS eligibility; * Patients' education; * Patients' referral to financial navigation resources; * Patients' reminder to discuss LCS during primary care provider (PCP) visit.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SCREENING
Masking
SINGLE
Enrollment
60
The usual care includes a provider flag in electronic medical record (EMR) on patients' eligibility for LCS if their smoking history is complete.
Brief one-page education material on lung cancer screening benefits and risk
Patients will be sent information (in preferred language) on lung cancer risk, lung cancer screening (LCS) benefits, harms, false positive rates, recommendations of follow-up for positive results, and exam insurance coverage.
Patients who self-report needing help with health-related social risks at baseline will be sent a brochure (in preferred language) from patient advocate foundation (PAF), a national non-profit financial navigation organization, where patients can self-refer.
within 2 weeks prior to appointment, patients will receive a text message or a phone call (if not having a phone that receives text messaging) encouraging patients to discuss lung cancer screening with their provider.
Within 2 weeks prior to primary care appointment, providers will be notified of their patient's eligibility for lung cancer screening and their reported barriers.
UCI Health Family Health Center - Anaheim
Anaheim, California, United States
UCI Health-Costa Mesa
Costa Mesa, California, United States
UCI Health-Irvine
Irvine, California, United States
UCI Health-Laguna hilla
Laguna Hills, California, United States
UCI Health-Newport
Newport Beach, California, United States
UCI Health SeniorHealth Center -Pavillion 4
Orange, California, United States
UCI Medical Center, Pavilion 3
Orange, California, United States
UCI Health Family Health Center - Santa Ana
Santa Ana, California, United States
UCI-Health Tustin
Tustin, California, United States
UCI Health-Yorba Linda
Yorba Linda, California, United States
Number of participants with order of Low-dose CT (LDCT) for lung cancer screening (LCS)
Time frame: Within 4 months of randomization
Number of Participants who received LDCT for LCS
Time frame: Within 4 months of randomization
Number of Participants with the documented discussion of lung cancer screening with their providers in the electronic medical record
Time frame: Within 4 months of randomization
Patients' perceived risk of lung cancer
3-item perceived risk of lung cancer questionnaire developed by Carter Harris et al (Cancer Nurs, 2018) will be used. The responses for each item will be based on a 5-point likert scale. A sum score will be calculated based on responses to all 3 item. Score will range between 3 and 15. Higher score= higher perceived risk.
Time frame: Baseline and 4 months after randomization
Patients' perceived severity of lung cancer
5-items about the health consequences and severity of lung cancer will be used. The responses for each item will be based on a 5-point likert scale. A sum score will be calculated based on responses to all items. Score will range between 5-25. Higher score= higher perceived benefits.
Time frame: Baseline and 4 months after randomization
Patients' perceived benefits of lung cancer screening
6-item perceived benefit of lung cancer questionnaire developed by Carter Harris et al (Cancer Nurs, 2018) will be used. The responses for each item will be based on a 5-point likert scale. A sum score will be calculated based on responses to all items. Score will range between 6-30. Higher score= higher perceived benefits.
Time frame: Baseline and 4 months after randomization
Patients' perceived barriers of lung cancer screening
19-item perceived barriers of lung cancer questionnaire will be used. 17 of these items were developed by Carter Harris et al (Cancer Nurs, 2018). The responses for each item will be based on a 5-point likert scale. A sum score will be calculated based on responses to all 17 validated items. Score will range between 17 and 85. Higher score= higher perceived barriers. An additional score including all 19 items will also be calculated.
Time frame: Baseline and 4 months after randomization
Patients' self-efficacy of lung cancer screening
10-item self-efficacy for lung cancer screening questionnaire will be used. 9 of these items were developed by Carter Harris et al (Cancer Nurs, 2018). The responses for each item will be based on a 5-point likert scale. A sum score will be calculated based on responses to all 9 validated item. Score will range between 9 and 45. Higher score= higher self-efficacy. An additional score including all 10 items will also be calculated.
Time frame: Baseline and 4 months after randomization
Patients' knowledge about lung cancer screening
9 questions adopted and modified from Volk R et al (PMID: 24518006) will be used. Responses will be based on true, false, unsure. Sum of correctly responded questions will be calculated. Higher score= higher knowledge.
Time frame: Baseline and 4 months after randomization
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