Need: Northeast (NE) Texas (Public Health Regions 4/5N) has among the highest rates of tobacco use and mortality from lung cancer in the state. In addition, over 30% of residents are within the age group eligible for lung cancer screening (LCS). UT Health East Texas is a leading provider of LCS services for persons in NE Texas through its Lung Nodule Program; however, there is a large unmet need for LCS in NE Texas, especially following recent eligibility criteria changes to lower the age and pack-year smoking requirements. Importantly, LCS must be preceded by a shared decision-making visit with a health care provider before a patient's first screening and should be paired with tobacco use s...

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Need: Northeast (NE) Texas (Public Health Regions 4/5N) has among the highest rates of tobacco use and mortality from lung cancer in the state. In addition, over 30% of residents are within the age group eligible for lung cancer screening (LCS). UT Health East Texas is a leading provider of LCS services for persons in NE Texas through its Lung Nodule Program; however, there is a large unmet need for LCS in NE Texas, especially following recent eligibility criteria changes to lower the age and pack-year smoking requirements. Importantly, LCS must be preceded by a shared decision-making visit with a health care provider before a patient's first screening and should be paired with tobacco use screening and cessation services to address the primary risk factor for lung cancer. Tobacco use screening and interventions are not being routinely provided to patients; known barriers include lack of knowledge about brief interventions and clinician time constraints coupled with unfamiliarity with/lack of use of evidence-based community treatment referral options like Tobacco Quitlines. Thus, in NE Texas there is a critical need for a multi-component program designed to enhance tobacco use screening, brief interventions, and referral for care, along with assessment of LCS eligibility, shared decision making, and navigation to diagnostic testing and, when needed, to treatment. Overall Project Strategy: Our aim is to increase access to and completion of LCS for persons who reside in Texas Public Health Region 4/5N and are at high risk of lung cancer due to past or present cigarette use. Centralized LCS programs are highly effective in providing cessation services for patients who smoke, have better follow-up care for patients who have abnormal findings on low-dose computed tomography, and patients seen in these programs are more adherent to annual screening compared to patients from de-centralized programs. Key features of centralized LCS programs are reliance of primary care clinicians to identify and refer patients eligible for screening, provision of smoking cessation and shared decision making by trained clinicians, and use of navigators for nodule management, patient tracking and follow-up, and quality improvement. This project will use a virtual, centralized model to deliver high-quality, guideline concordant LCS services through a collaboration between the UT Health East Texas, the largest provider of LCS services in NE Texas, and the MD Anderson Cancer Center's Tobacco Quitline and Decision Support Lab. By leveraging existing, complementary strengths of these two institutions, we will implement a novel program to deliver well-established, evidence-based clinical services (specifically, LCS and tobacco cessation) to persons who meet eligibility criteria from the U.S. Preventive Services Task Force and are at greatest risk for developing and dying from lung cancer due to cigarette exposure. Specific Goals: Equip clinicians from UT Health East Texas' Departments of Family Medicine, Internal Medicine, and Pulmonary/Lung Disease, and Family Circle of Care (an FQHC) with training so that they can screen all adult patients for tobacco use and routinely provide their adult patients who smoke cigarettes with brief evidence-based motivational(for patients who do not want to quit) or cessation interventions (for patients interested in quitting) with referral to more extensive Quitline care at each patient visit and measuring abstinence rates (Goal 1); and those who meet age and smoking history eligibility criteria with shared decision making about LCS and LDCT screening (Goal 2); while raising public awareness about LCS in NE Texas, with an emphasis on reaching medically underserved groups (Goal 3); and navigating patients with abnormal screening results to receive diagnostic testing and, for those with cancer, navigation into treatment (Goal 4). We will disseminate our program to other healthcare entities as part of Goal 3, using strategies that promise broad reach as supported by data from prior CPRIT awards. We estimate that over 314,000 people will be reached, and 182,000 people will be served through?131,000 direct educational, navigation, and clinical services during the project period. Significance and Impact: The virtual LCS program will increase public awareness of LCS in NE Texas; train clinicians to provide high quality tobacco screening, brief intervention and referral for in depth tobacco use cessation care, and, when eligible, shared decision making for LCS; and ensure patients with abnormal screening results receive timely follow-up diagnostic testing and treatment. Our program dissemination strategies, including technical assistance provision, will identify and coach other healthcare entities that could benefit from a similar multi-level program. This program will have a tremendous impact on lowering lung cancer incidence and mortality in a priority region of the state, with potential for future expansion.

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