Rural disparities affect utilization of and adherence to lung cancer screening (LCS), according to emerging evidence. Such discrepancies cannot be resolved by focusing strictly on the level of service at the radiology facility, but rather by directing more resources to provide services that help increase shared decision-making and guarantee follow-up.

A mixed-methods descriptive study was conducted that used surveys and semi-structured interviews of key informants. Results of the analysis were published in Annals of the American Thoracic Society.

The state of Oregon is largely rural, with approximately 33% of its inhabitants residing in areas that have been designated as rural (ie, geographic areas >10 miles from a population center that comprises >40,000 individuals).


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Recognizing that location-based disparities apply to LCS, the researchers sought to describe LCS radiologic services in rural Oregon to elucidate the barriers and facilitators to implementation of LCS using low-dose computed tomography (LDCT).

Researchers approached representatives from 37 small and rural hospitals in Oregon, conducting interviews of key informants from a subset based on implementation outcomes. Overall, representatives from a total of 29 radiology facilities were surveyed, with 18 key informants from 19 facilities that represented 12 health care systems being qualitatively interviewed.

Of the surveyed radiology facilities, 59% were carrying out LDCT for LCS. Based on feedback from the key informants, the facilities that performed this service were often motivated by community needs and less by financial gain or evidence strength. All of the key informants mentioned the importance of a champion. 

Implementation of LCS programmatic components that were within the normal scope of practice (eg, specification of LDCT parameters) for the key informants were described as being burdensome to establish but were surmountable barriers. According to the key informants, they were not responsible for other components of high-quality programs, such as guaranteeing adherence to recommended follow-up testing, noting that these steps should be the responsibility of patients’ primary care providers.

The investigators concluded that although many rural hospital facilities in Oregon provide LDCT for LCS, they do not carry out all the recommended components of a screening program. Champions were shown to be critical for initiating an LDCT service, with most radiology facilities offering some, but not all, of the components of the CHEST and American Thoracic Society guidelines. Additional interventions at the primary care level may thus be warranted.

Reference

Slatore CG, Golden SE, Thomas T, Bumatay S, Shannon J, Davis M. “It’s really like any other study”: rural radiology facilities performing low-dose computed tomography for lung cancer screening. Ann Am Thorac Soc. Published online June 15, 2021. doi:10.1513/AnnalsATS.202103-333OC