LEAD Pilot Study: Leveraging the Emergency Department to Address SDOH and Reduce Lung Cancer Screening Disparities
Summary
This is a pilot Type 1 Hybrid Effectiveness-Implementation Trial. The study will first examine reach in a non-traditional setting (the Emergency Department - ED) that uses an Electronic Health Record (EHR)-embedded Social Determinants of Health (SDoH) screening tool to identify lung screening-eligible patients for a tailored intervention to increase lung screening uptake. Reach is defined as the absolute number, proportion, and representativeness of individuals targeted for lung screening knowledge, awareness, and uptake. Then, a pilot trial will be conducted to examine the preliminary effectiveness of a tailored lung screening intervention compared to enhanced usual care to influence individual-level potential drivers of lung screening (health literacy, mistrust, stigma, fatalism, knowledge, lung screening health beliefs) and the ability to increase lung screening uptake among screening-eligible patients. Quantitative (Randomized Controlled Trial and EHR data) methods will be used for data collection and analysis to address the study aims.
Arms & interventions
- BehavioralLungTalk
Tailored lung screening intervention
- OtherNon-tailored lung screening
Non-tailored lung screening. It involves the addition of education to Social Determinants of Health (SDOH) screening and referral with patient navigation. Patients will be identified, and screened for SDOH needs using the UniteUs SDOH screener that is embedded in the Electronic Health Record (EHR), and connected to geographically-tailored resources (as described above under Arm 1). Participants will then be sent a non-tailored lung screening educational brochure via email to review that details lung cancer risk, lung screening facts, benefits, and potential harms. Within 48 hours, the Community Outreach and Engagement (COE) Patient Navigator will contact the patient to answer questions and provide navigation services as described above in Arm 1.
Outcome measures
Primary
Lung Cancer Screening Uptake
Completion of a Screening Low-Dose Computed Tomography (LDCT) of the Chest confirmed via Electronic Health Records (EHR))
Time frame: Assessed at 1 month and 6 months post intervention
Stage of Adoption for Lung Cancer Screening
Screening Intention will be assessed with the Stage of Adoption for Decision- Making About Lung Screening using an algorithm of questions used in our prior studies assessing the 7 stages (unaware, aware but unengaged, undecided, decided not to act, decided to act, action, and maintenance). This will allow investigators to assess intent.
Time frame: Assessed at 1 week and then at 1 month and 6 months post intervention
Secondary
Health Literacy Scale
Time frame: At one week and one month post intervention
Medical Mistrust Scale
Time frame: At one week and one month post intervention
Perceived Stigma Scale
Time frame: At one week and one month post intervention
Perceived Risk of Lung Cancer Scale
Time frame: At one week and one month post intervention
Perceived Benefits of Lung Cancer Screening Scale
Time frame: At one week and one month post intervention
Perceived Barriers to Lung Cancer Screening Scale
Time frame: At one week and one month post intervention
Self-Efficacy for Lung Cancer Screening Scale
Time frame: At one week and one month post intervention
Knowledge: Lung Cancer and Screening Scale
Time frame: At one week and one month post intervention
Lung Cancer Fatalism
Time frame: At one week and one month post intervention
Eligibility criteria
Study locations (10)
Ocean Medical Center
Brick, New Jersey, 08724
John F. Kennedy Medical Center
Edison, New Jersey, 08820
Hackensack University Medical Center
Hackensack, New Jersey, 07601
Bayshore Medical Center
Holmdel, New Jersey, 07733
Southern Ocean Medical Center
Manahawkin, New Jersey, 08050
Jersey Shore University Medical Center
Neptune City, New Jersey, 07753
Palisades Medical Center
North Bergen, New Jersey, 07047
Old Bridge Medical Center
Old Bridge, New Jersey, 08857
Raritan Bay Medical Center
Perth Amboy, New Jersey, 08861
Riverview Medical Center
Red Bank, New Jersey, 07701
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