Lung cancer screening care pathways in community settings: an examination of 3 healthcare systems

BACKGROUND: Lung cancer screening (LCS) with low-dose computed tomography (LDCT) is recommended for individuals ages 50-80 with a high-risk tobacco history, but implementation of LCS in community settings remains a significant challenge. The benefits of LCS are tempered by both low uptake and low adherence to recommended follow-up, supporting the need for community-engaged research in this area. OBJECTIVE: The objective of this study was to understand LCS workflows throughout the care continuum in representative community-care settings. DESIGN: This is a case study informed by multi-method data collection to characterize 3 community-based LCS programs in Washington state that are participating in a hybrid effectiveness-implementation trial to enhance LCS program care coordination. PARTICIPANTS: This research was conducted in collaboration with 3 community-based LCS referral programs. Participants included program partners who participated in formalized site visits and interviews. APPROACH: To develop and refine LCS workflows, we triangulated data from rapid ethnographic assessment site visits (n = 5), semi-structured interviews with care providers (n = 15), and member checking with key programmatic partners from each site. The rapid group analysis process was used to integrate findings and guide the development and visualization of LCS workflows. KEY RESULTS: The 3 community-based programs provide LCS services for their regional primary care networks with various levels of centralized programmatic support. LCS workflows from each site demonstrate varied staff involvement and resources along the LCS care continuum. Provider interviews identified the need for patient education and outreach, provider support and resources, and attention to gaps in care along the LCS continuum. CONCLUSION: The LCS system-level workflows demonstrate 3 approaches to LCS care in community settings. LCS workflows can enable the timely identification of barriers and facilitators to improving LCS implementation in community settings.