Need: Evidence-based interventions to effectively decrease preventable disease, disability, and death caused by tobacco use are much needed in East Texas. East Texas is a rural and underserved region facing significant barriers, including a higher prevalence of active smokers, lower socioeconomic status, lower education levels, and many residents are uninsured or underinsured, all of which contribute to reduced adherence to cancer screening and follow-up. In this proposed service area, smoking prevalence is higher than the national average of 15%, reaching up to 20% in some counties. As a result, we intend to leverage our success by adapting our centralized process to implement lung cancer s...

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Need: Evidence-based interventions to effectively decrease preventable disease, disability, and death caused by tobacco use are much needed in East Texas. East Texas is a rural and underserved region facing significant barriers, including a higher prevalence of active smokers, lower socioeconomic status, lower education levels, and many residents are uninsured or underinsured, all of which contribute to reduced adherence to cancer screening and follow-up. In this proposed service area, smoking prevalence is higher than the national average of 15%, reaching up to 20% in some counties. As a result, we intend to leverage our success by adapting our centralized process to implement lung cancer screening within a virtually integrated system in this 36-county subset supported by satellite screening sites to be identified throughout the funding period. Through this proposed project, we will target approximately 58,00 screen-eligible patients, providing opportunities to participate in comprehensive lung cancer screening, serving at least 720 patients with nurse-driven clinical navigation, screening, and follow-up care, while further supporting these efforts with tobacco cessation education and counseling. Overall Project Strategy: Saved by the Scan: Lung Cancer Screening and Patient Navigation in East Texas will leverage the existing framework including community outreach and health promotion, comprehensive lung cancer screening with nurse-driven clinical navigation through follow-up and treatment where appropriate, supported by tobacco cessation education and counseling and education, and centralized reimbursement for local providers to support patients who are either uninsured or underinsured. Our evidence-based program will bring lung cancer screening into real-world settings across 36 rural and underserved counties in East Texas. Providers identified through targeted community outreach will refer screen-eligible patients to the program following shared decision-making. These patients will then receive lung cancer screening supported by telephone-based navigation, with tobacco cessation education counseling being offered to patients who are active smokers. The program team will facilitate care linkage, with services provided by regional clinical partners. The proposed program will provide multilevel support to ensure the completion of the lung cancer screening process, up to and including the start of treatment. A patient-centered approach to quality metrics will standardize the evaluation approach, allowing for comparisons between organ sites and identifying potential intervention points within the screening process to support the optimization of delivery and improve screening process outcomes. Specific Goals: The primary intent of this proposal is to implement our successful comprehensive lung cancer screening program in 36 counties in East Texas. Through coordinated outreach efforts, the project will reach more than 58,800 screen-eligible patients aged 50-80 who have at least a 20-pack-year smoking history and either currently smoke or have quit within the past 15 years. The program will provide at least 720 patients with clinical services. The specific goals are: 1) implementing a lung cancer screening program using low-dose computerized tomography (LDCT) combined with centralized processes, including shared decision-making and patient navigation, to promote screening completion and evidence-based follow-up; and 2) supporting implementation of lung cancer screening using LDCT with evidence-based education and counseling to reduce tobacco use within the target population. Significance and Impact: Leveraging the successful methodology of the LSPAN program, the implementation in East Texas will remove barriers like cost, access, and difficulties navigating the healthcare system, enabling even more patients to receive the recommended clinical services. It will also add a primary preventative component of tobacco cessation education and counseling. Preventive services will be made available to communities disproportionately affected by cancer, such as low-income, minority, uninsured, or underinsured patients living in rural and underserved counties throughout East Texas, by utilizing the state's current infrastructure and the effective county-tailored delivery model.

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