Lung cancer is the deadliest cancer in the country, causing almost 20% of all cancer deaths – and most cases (53%) are only detected at an advanced stage, while the survival rate is only 8%. Its effects are not equal either: 16% of Black Americans suffer from lung cancer. less likely survive five years compared to white Americans.
Why is that? A major problem is the lack of early detection through screening. Despite evidence that screening in high-risk populations reduces mortality by up to 20%, uptake of screening has remained low, with only about 6% of eligible patients having undergone lung cancer screening. Black Americans with lung cancer account for 15% less likely be diagnosed early compared to white individuals in America, demonstrating a harmful disparity in early detection.
More than 60% of the 27.5 million Uninsured non-elderly Americans are people of color, illustrating a problem with access to preventive care and early detection. But beyond access, many cultural, social and economic barriers prevent people of color from being screened for lung cancer as often as their white counterparts. These range from historical distrust of the medical system to multigenerational living and caregiving responsibilities that make attending in-person appointments difficult.
“It’s not just about insurance, we realized that. A lot of it comes down to trust,” said Susan Garwood, MD, national physician director of pulmonary diseases at HCA Healthcare.
Dr. Garwood is helping lead HCA Healthcare’s new pilot program to increase lung cancer screenings among non-white populations. The program, which underwent an alpha pilot phase at TriStar Centennial Medical Center in Nashville, Tennessee, and recently expanded to a beta pilot phase in Richmond, Virginia, is designed to help overcome some of the trust barriers that prevent people to get tested.
Identify eligible patients
One of the first hurdles is the need to better understand eligibility. Many patients are unaware of screening guidelines, whether American Cancer Society updated earlier this month. These updated guidelines mean more people than ever are eligible for testing without knowing it.
“People at greatest risk for lung cancer are smokers or former smokers, and this education is critical,” said Regina Bowe, MD, a physician at the Frist Clinic in the TriStar division of HCA Healthcare. “If you don’t know that testing is available, you won’t tell your providers. It’s not like mammograms, colonoscopies, and Pap tests, which are discussed regularly as part of your preventative health care.
The pilot program is designed to reach eligible patients and expand early testing by leveraging technology to identify potential candidates. Care navigators then flag appropriate patients for follow-up calls to determine if they meet screening requirements, helping to proactively identify individuals who should consider screening.
“When we think about lung cancer screening, we typically expect doctors to push these patients to get screened,” says Dr. Garwood. “Instead, this program attempts to attract patients, meet them where they are, and take some of the burden off the primary care physician.”
This is essential since doctors often focus on treating patients for what they came for. They need additional time to proactively search records for other issues to follow up with all potentially eligible patients. This is why Dr. Bowe chose to be a part of the program.
“I felt like I would reach more people if I wasn’t the one making that phone call,” she explained. “There is a group of people directly responsible for finding my at-risk patients, who I might miss because of the many other ways I work to treat them.”
Increasing the number of eligible people who should be screened could have a significant impact. Currently, 14.2 million Americans are eligible for lung cancer screening. Based on HCA Healthcare’s market size, approximately 750,000 patients passing through its facilities are eligible. Identifying and increasing the number of screenings for these patients can make a huge difference, especially in underserved communities.
Reach out and build trust
Once potentially eligible patients are identified, the next step is awareness. For many people who are distrustful of the healthcare system, it can be discouraging to have someone other than their doctor contact them about their health. The program’s care navigators are trained to manage these conversations and overcome these barriers.
“The key to success is triggering a medical record, which identifies potentially eligible patients who are then brought to the attention of care navigators,” Dr. Garwood said. “Care navigators are working to overcome barriers to screening, including the issue of trust.”
Navigators and providers in the pilot program are trained to more easily overcome barriers using a “HealthCaring Conversations” toolkit, a behavioral health-informed communication framework developed in collaboration with Johnson behavioral scientists & Johnson Health and Wellness Solutions.
“When they were preparing the questionnaires and the patients to contact, it was important that our questions were culturally and socially appropriate,” Dr. Bowe explained. “We wanted to eliminate some of the fear that comes with testing as it relates to people being targeted because of their race, socioeconomic status or ethnicity. »
The human aspect is key, as the Care Navigator can notify patients that they are eligible and alert their doctors, helping to ensure that eligible patients are flagged for screening at their next appointments.
“The key is for our care coordinators to be able to have that conversation with patients and then quickly connect them with an advanced practice provider,” says Dr. Garwood.
Dedicated attention and monitoring
The other major role of care navigators, beyond establishing initial trust, is their ongoing support in helping each patient overcome barriers to accessing care. By asking the right questions, the care navigator can help identify potential issues, such as payment, transportation or language barriers, and connect patients and their families with resources that can help.
“A lot of it depends on who you interact with in the family,” Dr. Garwood said. “For example, women tend to lead health care decision-making, so engaging with their spouse or having a grandmother present can be essential. We’re learning more about the obstacles and possible opportunities, and that’s the beauty of this pilot project.
The care navigator also ensures patients show up for follow-up appointments, which is critical to improving survival rates. Data indicates that approximately 70% of people with incidental findings or abnormal screens do not receive the necessary follow-up after two years, and care navigators spend time in follow-up conversations to ensure compliance.
“If we think about what we do and what lessons other health systems could learn from, I think care coordinators are essential,” says Dr. Garwood. “It is not a problem that equipment or technology changes. You still need a human element to be successful and connected. It’s important to have that critical piece, that investment in care coordinators and navigators.
Next steps
Over the past 18 months, the Lung Health Program has helped increase the percentage of all populations, including people of color, who are screened for lung cancer at HCA Healthcare locations in the Nashville and Richmond areas .
HCA Healthcare is looking to expand the program to reach even more communities. “I’m excited about how we can expand the program beyond the walls of HCA Healthcare in partnership with nonprofits and others, and share what other health systems can do to help improve health equity and reduce lung cancer deaths across the country,” said Dr. Garwood.
