Exploring facilitators and barriers to low-dose CT screening for lung cancer among Native American patients: The TEALS study

Abstract Purpose: Lung cancer screening (LCS) with low dose CT scanning reduces mortality but uptake of LCS is poor. Lung cancer mortality in Oklahoma’s Native American population is 45% higher than for the non-Hispanic White population. The Tribally Engaged Approaches to Lung Screening (TEALS) study is a collaboration between the University of Oklahoma Health Sciences Center and the Choctaw Nation of Oklahoma Health Services Authority (CNHSA). The goals of TEALS are to implement a systematic LCS program within Choctaw Nation and to understand LCS decision-making processes, barriers and facilitators. Procedures: Using purposive sampling from 2 of 8 CNHSA clinics in Oklahoma in 2021, we conducted a pilot study using phone interviews with patients who had completed LCS and those who had not. Using a semi-structured interview guide, we asked patients about their experience with the LCS program, factors that influenced their decision, and suggestions for improving the program. Conventional inductive content analysis was used to identify major themes. Multiple coders and peer debriefing enhanced scientific rigor. Results: Completers (4 men and 5 women) and non-completers (3 men and 3 women) were included. Major themes included: (1) Contextual factors influencing the decision-making process; (2) Individual characteristics influencing the decision-making process; and (3) Barriers to screening. Contextual factors included the provider raising the discussion of LCS, which was most frequently cited by completers but not the non-completers. Other contextual factors included the use of handouts and pamphlets during clinic visits. Patient suggestions included brochures/posters in waiting rooms and creating an information video to run on TVs in waiting areas. Individual characteristics included motivation to ‘be there’ for family/children, previous cancer in family/friends, and ease of arranging appointments. Non-completers preferred not to know or were scared to know the results of screening. Barriers included long distance travel to LCS sites, missing work, access to transportation or assistance, confusion about the appointment leading to missed appointments. Interviews highlighted the need to clarify eligibility criteria. Notably, some patients who were classified as ‘non-completers’ had already had a diagnostic CT for respiratory symptoms or as follow-up for prior cancer, indicating a gap in correctly identifying LCS eligibility. Conclusions: Findings from this pilot have guided implementation of the TEALS clinical trial. Large banners are now available in participating clinics. Academic detailing ensures the decision aid pamphlet is available and used in waiting rooms. Providers are reminded of the critical role they play in informing patients about LCS. Appointment reminders and assistance with transportation (e.g., tribal transportation) are in place. Eligibility criteria for the clinical trial have been clarified. Gathering this information from pilot study participants has enabled the team to refine the LCS intervention as it expands to other sites. Citation Format: Kathleen Dwyer, Dorothy A. Rhoades, Mark Doescher, Brook McCann, Michele Gibson, Zsolt Nagykaldi. Exploring facilitators and barriers to low-dose CT screening for lung cancer among Native American patients: The TEALS study [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A101.