A Lung Cancer Screening Education Program Impacts both Referral Rates and Provider and Medical Assistant Knowledge at Two Federally Qualified Health Centers

•Low referral rates by providers limits utilization of lung cancer screening.•Education benefits high-risk populations at Federally Qualified Health Centers.•Education increases provider knowledge about lung cancer screening.•Education increases medical assistant knowledge about lung cancer screenin...

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Published inClinical lung cancer Vol. 23; no. 4; pp. 356 - 363
Main Authors Akhtar, Aamna, Sosa, Ernesto, Castro, Samuel, Sur, Melissa, Lozano, Vanessa, D'Souza, Gail, Yeung, Sophia, Macalintal, Jonjon, Patel, Meghna, Zou, Xiaoke, Wu, Pei-chi, Silver, Ellen, Sandoval, Jossie, Gray, Stacy W., Reckamp, Karen L., Kim, Jae Y., Sun, Virginia, Raz, Dan J., Erhunmwunsee, Loretta
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 01.06.2022
Subjects
Carcinoma, Non-Small-Cell Lung - diagnosis
Early Detection of Cancer - methods
FQHCs
Humans
LCS barriers
LDCT
Lung Neoplasms - diagnosis
Referral and Consultation
Smokers
Underserved populations
SES
NSCLC
LCS barriers
HEDIS
CMS
LDCT
EMR
FQHCs
USPSTF
NCI
HCHC
Underserved populations
NLST
LCS
SDM
MAs
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Summary:•Low referral rates by providers limits utilization of lung cancer screening.•Education benefits high-risk populations at Federally Qualified Health Centers.•Education increases provider knowledge about lung cancer screening.•Education increases medical assistant knowledge about lung cancer screening.•Lung cancer screening referral rates are increased with comprehensive education. Federally Qualified Health Centers (FQHCs) serve minority and low-socioeconomic populations and provide care to high-risk smokers. These centers frequently experience barriers, including low provider and medical assistant (MA) knowledge around lung cancer screening (LCS). Subsequent low LCS referral rates by providers at FQHCs limit utilization of LCS in eligible, high-risk, underserved patients. Providers and MAs from two FQHCs participated in a LCS educational session. A pre-educational survey was administered at the start of the session and a post-educational survey at the end. The intervention included a presentation with education around non-small cell lung cancer, LCS, tobacco cessation, and shared-decision making. Both surveys were used to evaluate changes in provider and MA ability to determine eligible patients for LCS. The Pearson's Chi-squared test with Yates' continuity correction was used to measure the impact. A total of 29 providers and 28 MAs enrolled in the study from two FQHCs. There was an improvement, P < .009 and P < .015 respectively, in provider and MA confidence in identifying patients for LCS. Additionally, one year prior to the program, 9 low-dose computed tomography (LDCTs) were ordered at one of the FQHCs and 0 at the other. After the program, over 100 LDCTs were ordered at each FQHC. A targeted LCS educational program improves provider and MAs’ ability to identify eligible LCS patients and is associated with an increase in the number of patients referred to LDCT at FQHCs. Low LCS referrals at FQHCs may worsen NSCLC disparities in marginalized populations. We implemented a program at two FQHCs that provided LCS education to 57 providers and MAs. After the program, there was a significant increase in both LCS referrals as well as provider and MA ability to identify eligible LCS participants at FQHCs. [Display omitted]
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4. Melissa Sur: Writing – original draft
8. Jonjon Macalintal: Conceptualization, methodology, and writing – review & draft.
6. Gail D’Souza: Conceptualization, investigation, resources, data curation, writing – original draft, writing – review & editing, and project administration.
9. Meghna Patel: Writing – original draft.
13. Jossie Sandoval: Conceptualization, methodology, validation, and writing – review & editing
14. Stacy W. Gray: Conceptualization, methodology, validation, and writing – review & editing
3. Samuel Castro: Conceptualization, resources, data curation, investigation, resources, writing – original draft, writing - review & editing, and project administration.
7. Sophia Yeung: Conceptualization, methodology, and writing – review & draft.
Statement of Author’s Contribution
10. Xiaoke Zou: Software, validation, data curation and formal analysis.
17. Virginia Sun: Conceptualization, methodology, validation, and writing – review & editing.
11. Pei-chi Wu: Writing – review & editing and supervision.
19. Loretta Erhunmwunsee: Conceptualization, methodology, validation, writing – original draft, writing – review & editing, supervision, project administration, and funding acquisition.
1. Aamna Akhtar: Conceptualization, methodology, investigation, resources, data curation, writing - original draft, writing – review & editing, visualization, and project administration.
15. Karen L. Reckamp: Conceptualization, methodology, validation, and writing – review & editing.
2. Ernesto Sosa: Formal analysis, resources, data curation, writing – original draft, writing – review & editing, and visualization.
16. Jae Kim: Writing – review & editing.
12. Ellen Silver: Writing – review & editing and supervision.
5. Vanessa Lozano: Conceptualization, data curation, investigation, resources, writing – original draft, writing – review & editing, and project administration.
18. Dan J. Raz: Conceptualization, methodology, validation, and writing – review & editing.
ISSN:1525-7304
1938-0690
DOI:10.1016/j.cllc.2021.12.002