Breaking down barriers to improve lung cancer health

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Headshot of Dr.  Regina Bowe

Lung cancer is the deadliest cancer in the country, causing almost 20% of all cancer deaths – and most cases (53%) are not caught until a late stage, when the survival rate is only 8%. Its effects are not uniform, either: Black Americans with lung cancer are 16% less likely to survive five years compared to white Americans.

Why? A major issue is the lack of early detection through screening. Despite evidence that screening high-risk populations can reduce mortality by up to 20%, uptake is low, with only about 6% of eligible patients screened for lung cancer. Black Americans with lung cancer are 15% less likely to be diagnosed early compared to white individuals in America, showing a devastating difference in early screening.

More than 60% of the 27.5 million uninsured elderly Americans are people of color, illustrating an issue 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 include everything from historical mistrust of the medical system to multigenerational living and caregiving responsibilities that make attending in-person appointments challenging.

“It’s not just an insurance issue, we know. A lot of it has to do with trust,” said Susan Garwood, MD, National Physician Director of Pulmonary Disease at HCA Healthcare.

Helping Dr. Garwood to lead HCA Healthcare’s new pilot program to increase lung cancer screenings among non-white populations. The program, which has 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 person to be screened.

Identifying eligible patients

Headshot Of Dr.  Regina BoweHeadshot Of Dr.  Regina Bowe

One of the first roadblocks is the need for more understanding about eligibility. Many patients are unaware of the screening guidelines, which were updated by the American Cancer Society earlier this month. These updated guidelines mean that more people than ever are eligible for screening and may not know it.

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“The people most at risk for lung cancer are smokers or former smokers, and that education is key,” said Regina Bowe, MD, a physician at The Frist Clinic in the TriStar Division of HCA Healthcare. “If you don’t know screening is available, it’s not something you talk to your providers about. It’s not like mammograms and colonoscopies and Pap smears, which are often discussed as part of your preventive health care.”

The pilot program is designed to reach eligible patients and expand early testing by using 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 people who should consider being screened.

“When we think about lung cancer screening, we usually wait for doctors to push patients to a screening,” explained Dr. Garwood. “Instead, this program is trying to pull patients in, to meet the patient where they are and to take some of the burden off the primary care physician.”

This is critical because doctors often focus on treating patients for what they come from. They need more time to look at records for other active issues to follow up on all possible patients. That’s why Dr. Bowe to be part of the program.

“I feel like I can reach more people if I’m not the only one on the phone,” he explained. “There is a group of people who are directly charged with finding my patients who are at risk, which I may forget because of the many other ways I am working to treat them.”

Increasing the number of eligible people who need to be screened can 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 who pass through its facilities are eligible. Identifying and increasing the number of screenings for patients can make a big difference, especially in underserved communities.

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Reach out and build trust

Headshot Of Dr.  GarwoodHeadshot Of Dr.  Garwood
Susan Garwood, MD, National Physician Director of Pulmonary Disease at HCA Healthcare

Once potential eligible patients are identified, the next step is outreach. For many people who do not trust the health care system, it can be uncomfortable to have someone other than their doctor contact them about their health. The program’s care navigators are trained to manage conversations and overcome roadblocks.

“The key to success is a medical record trigger, which identifies potentially eligible patients who are then brought to the attention of care navigators,” said Dr. Garwood. “Care navigators work to overcome barriers to screening, including the issue of trust.”

Navigators and providers in the pilot program were trained to more easily overcome barriers using the “HealthCaring Conversations” toolkit, an informed health behavior communication framework developed in collaboration with behavioral scientists at Johnson & Johnson. Health and Wellness Solutions.

“When they come up with questions and which patients to reach, it’s important that our questions are appropriate from a cultural and social standpoint,” explained Dr. Bow. “We want to remove 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 critical, as the care navigator can inform patients that they are eligible and alert their physicians, helping to ensure that eligible patients are flagged for screening at their next visit. appointment.

“The key is our care coordinators being able to talk to patients and then connect them with an advanced practice provider,” said Dr. Garwood.

Dedicated focus and follow-up

Another major role of care navigators, beyond building initial trust, is their ongoing support to help each patient navigate the obstacles on the way to care. By asking the right questions, the care navigator can help identify potential problems, such as payment, transportation or language barriers, and connect patients and their families to resources that can help.

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“A lot of it has to do with who you include within the family,” says Dr. Garwood. “For example, women tend to be in charge of health care decision-making, so getting the wife involved or having a grandmother there can be key. We’re learning more about where our barriers are. and opportunities, and that’s the beauty of this pilot project.

The care navigator also ensures that patients attend follow-up appointments, which is important in improving survival rates. The data show that nearly 70% of people with incidental findings or abnormal screens do not get the necessary follow-up for two years, and care navigators sets aside time for follow-up conversations to ensure compliance.

“When we think about what we’re going to share that we’re doing well and what other health systems are going to learn, I think care coordinators are important,” said Dr. Garwood. “It’s not a problem that a piece of equipment or technology changes. You need a human element for success and connection. It’s important to have that critical piece, that investment in care coordinators and navigator.

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 facilities in the Nashville and Richmond areas.

HCA Healthcare is looking to expand the program to reach more communities. “I’m excited about the ways we can expand the program beyond the walls of HCA Healthcare in partnership with nonprofits and other organizations, and to share what other health care systems can do to can help improve health equity and reduce lung cancer deaths throughout the country,” said Dr. Garwood.