Developing a Trustworthy Multilevel Intervention to Improve Equity in Lung Cancer Screening

Modified Project Summary/Abstract Section PROJECT SUMMARY/ABSTRACT Lung cancer screening using low-dose computed tomography significantly reduces lung cancer mortality, the leading cause of cancer mortality in the United States. Despite its life-saving potential, lung cancer screening uptake remains extremely low among eligible populations (about 5%). Lung cancer screening utilization is even

lower among populations that experience a disproportionate burden of lung cancer (e.g., Black and low-income Americans). In November 2021, the U.S. Preventive Services Task Force (USPSTF) called for more evidence to increase equity in lung cancer screening uptake in their Annual Report to Congress. Yet, multilevel barriers

to lung cancer screening exist at the patient, provider, and health system levels. However, prior research assessing these barriers is limited by inadequate racial, ethnic, and socioeconomic diversity among participants and exclusion of key health care staff (e.g., nurses) who often champion screening programs.

Medical mistrust is another commonly reported screening barrier. Yet, mistrust is often studied as a patient- level barrier, ignoring that mistrust arises from structures, such as racism in health care. Many health care interventions also lack trustworthiness, partly because they are often designed without community input. Little

is known about how screening barriers can be addressed through implementation strategies that center equity and have an explicit goal to earn patient trust. Through three specific aims, this study will address these knowledge gaps. These aims are to: 1) identify multilevel barriers and facilitators to the equitable

implementation of lung cancer screening (K99 phase), 2) engage with community advisors and key stakeholders to identify multilevel implementation strategies to promote equity in lung cancer screening (K99 phase), and 3) pilot test the feasibility of multilevel implementation strategies designed to equitably improve

lung cancer screening uptake (one at the patient level and one at the provider/system level, R00 phase). To complete these research aims, the candidate (Dr. Jennifer Richmond) requires didactic and mentored training in lung cancer leadership, implementation science, and methods for designing/evaluating multilevel health

equity interventions. Dr. Richmond has assembled an outstanding mentoring team (Drs. Melinda Aldrich, Consuelo Wilkins, Eric Grogan, and Carolyn Audet) with collective expertise in these areas to help her achieve the research and training goals. Overall, this innovative study will be among the first to respond to the USPSTF

call for evidence to increase lung cancer screening equity. It will also lay the groundwork for a R01 application to evaluate the intervention pilot tested in this study. With support from her mentors and the exceptional training and research environment at Vanderbilt University Medical Center, Dr. Richmond will reach her long-

term goal of transitioning to independence and becoming a national leader in lung cancer equity research.