Need: Lung cancer (LC) screening using low-dose computed tomography (LDCT) among at-risk adults can reduce morbidity and mortality. However, implementation and uptake of screening is low, particularly for those living in rural areas, the uninsured, and those with low English language proficiency. Primary care clinicians serving these communities are often not aware of evolving guidelines and what they can do to increase screening and reduce risks among their patients. Active dissemination of a successful LC screening program that has achieved success at improving outreach among underserved communities in both urban and rural communities may be achieved through education, training, and outrea...

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Need: Lung cancer (LC) screening using low-dose computed tomography (LDCT) among at-risk adults can reduce morbidity and mortality. However, implementation and uptake of screening is low, particularly for those living in rural areas, the uninsured, and those with low English language proficiency. Primary care clinicians serving these communities are often not aware of evolving guidelines and what they can do to increase screening and reduce risks among their patients. Active dissemination of a successful LC screening program that has achieved success at improving outreach among underserved communities in both urban and rural communities may be achieved through education, training, and outreach among primary care clinicians across Texas. The TEX-CARE education course will include an interactive website and toolkit that will provide primary care clinicians with key information on implementing LC screening in their practice and provide guides on strategies for patient follow-up. Web-based education modules will include active learning strategies, including case-based activities and infographics or videos, that will engage practicing clinicians in activities that are developed to: 1) improve their confidence in implementing identification of eligible patients according to current guidelines, 2) include strategies to effectively educate, refer, and follow-up with patients for LDCTs, and 3) instruct clinicians on providing evidence-based smoking cessation services. The toolkit will consist of materials that clinicians can use to implement TEX-CARE in their practices. For example, a list of LDCT locations across Texas, screening tools, updated guidelines, a replication guide that will provide information specific to both rural and urban practices, and strategies to follow-up with patients about results and future screenings. The TEX-CARE toolkit will be provided to all clinicians that complete the web-based education program. We have shown, through our previous CPRIT-funded work, that implementing a process to identify and refer eligible patients to LDCT in underserved urban patients in Harris County and rural counties, including Brazoria and Angelina Counties, increases screening. However, much of the state remains underserved with respect to LC screening for uninsured patients, especially those in rural areas. Expanding access to LDCT for at-risk patients requires training of practicing primary care providers and partnerships with primary healthcare entities across Texas. Overall project strategy: Through the Dissemination of CPRIT-Funded Cancer Control Interventions award process, we seek to develop an evidence-informed blueprint, implementation guide, web-based education modules, and consultation service for expanding referral and access to LDCT screening to eligible patients in underserved areas of Texas, in cooperation with other Texas institutions and community groups. Our team has extensive experience in developing and implementing interventions to improve LC screening in vulnerable populations through primary healthcare networks. In addition, we bring expertise in the use of geographic information systems (GIS) to identify areas of the greatest need, experience in long-distance education for primary care clinicians across Texas, and experience in forming coalitions of diverse stakeholders around a common health goal. Specific goals: We propose to form an expert team to 1) identify areas of Texas in high need of LC screening improvement (low screening rates, high incidence and mortality); and 2) Develop a toolkit and recruit primary care clinicians to learn evidence-based strategies for lung cancer prevention and plan new lung cancer screening programs for high-need areas in Texas using active dissemination strategies that include online training, technical assistance, and individual consultation. Significance and Impact: Our goal is to identify areas in most need and actively disseminate education on LC screening and prevention to clinicians working in underserved Texas communities. By taking advantage of the low-cost and scalability of online education as a means of training clinicians in underserved and rural communities, we can increase LC screening rates, reduce health disparities, and serve as a model for other states.

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