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. 2023 Oct 30;23(1):1179.
doi: 10.1186/s12913-023-10185-4.

Individual- and neighborhood-level characteristics of lung cancer screening participants undergoing telemedicine shared decision making

Christine S Shusted  1 , Hee-Soon Juon  2 , Brooke Ruane  1 , Brian Till  3 , Charnita Zeigler-Johnson  2 , Russell K McIntire  4 , Tyler Grenda  3 , Olugbenga Okusanya  3 , Nathaniel R Evans  3 , Gregory C Kane  1 , Julie A Barta  5
Affiliations

Individual- and neighborhood-level characteristics of lung cancer screening participants undergoing telemedicine shared decision making

Christine S Shusted et al. BMC Health Serv Res. .

Abstract

Background: Although lung cancer screening (LCS) for high-risk individuals reduces lung cancer mortality in clinical trial settings, many questions remain about how to implement high-quality LCS in real-world programs. With the increasing use of telemedicine in healthcare, studies examining this approach in the context of LCS are urgently needed. We aimed to identify sociodemographic and other factors associated with screening completion among individuals undergoing telemedicine Shared Decision Making (SDM) for LCS.

Methods: This retrospective study examined patients who completed Shared Decision Making (SDM) via telemedicine between May 4, 2020 - March 18, 2021 in a centralized LCS program. Individuals were categorized into Complete Screening vs. Incomplete Screening subgroups based on the status of subsequent LDCT completion. A multi-level, multivariate model was constructed to identify factors associated with incomplete screening.

Results: Among individuals undergoing telemedicine SDM during the study period, 20.6% did not complete a LDCT scan. Bivariate analysis demonstrated that Black/African-American race, Medicaid insurance status, and new patient type were associated with greater odds of incomplete screening. On multi-level, multivariate analysis, individuals who were new patients undergoing baseline LDCT or resided in a census tract with a high level of socioeconomic deprivation had significantly higher odds of incomplete screening. Individuals with a greater level of education experienced lower odds of incomplete screening.

Conclusions: Among high-risk individuals undergoing telemedicine SDM for LCS, predictors of incomplete screening included low education, high neighborhood-level deprivation, and new patient type. Future research should focus on testing implementation strategies to improve LDCT completion rates while leveraging telemedicine for high-quality LCS.

Keywords: Health disparities; Lung cancer; Lung cancer screening; Screening adherence; Telemedicine.

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Conflict of interest statement

JB reports research grants from the Genentech Health Equity Innovations Fund outside the submitted work. The remaining authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Neighborhood Deprivation Index (NDI) by Philadelphia Census Tract. A NDI quartiles B). Bivariate choropleth map of NDI and patient count among the Complete Screening Subgroup. C Bivariate choropleth map of NDI and patient count among the Incomplete Screening Subgroup. Maps were generated using ArcGIS Pro, 2.5 Ed. Redlands, CA; ESRI, 2020
See this image and copyright information in PMC

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