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Challenges Implementing Lung Cancer Screening in Federally Qualified Health Centers

  • Steven B. Zeliadt
    Correspondence
    Address correspondence to: Steven B. Zeliadt, PhD, Department of Health Services, School of Public Health, University of Washington, Box 3358280, Seattle WA 98195][issn]/$36#36.00$06#?>$^doi_string?>
    Affiliations
    Department of Health Services, School of Public Health, University of Washington, Seattle, Washington

    Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Health Administration, Seattle, Washington
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  • Richard M. Hoffman
    Affiliations
    Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa

    Holden Comprehensive Cancer Center, Iowa City, Iowa
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  • Genevieve Birkby
    Affiliations
    Center for Community Health Integration and the Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, Ohio
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  • Jan M. Eberth
    Affiliations
    Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina

    Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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  • Alison T. Brenner
    Affiliations
    Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
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  • Daniel S. Reuland
    Affiliations
    Department of Medicine, Division of General Internal Medicine, University of North Carolina, Chapel Hill, North Carolina
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  • Susan A. Flocke
    Affiliations
    Center for Community Health Integration and the Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, Ohio

    Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio

    Cancer Prevention, Control and Population Research, Case Comprehensive Cancer Center, Cleveland, Ohio
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Published:February 08, 2018DOI:https://doi.org/10.1016/j.amepre.2018.01.001

      Introduction

      The purpose of this study is to identify issues faced by Federally Qualified Health Centers (FQHCs) in implementing lung cancer screening in low-resource settings.

      Methods

      Medical directors of 258 FQHCs serving communities with tobacco use prevalence above the median of all 1,202 FQHCs nationally were sampled to participate in a web-based survey. Data were collected between August and October 2016. Data analysis was completed in June 2017.

      Results

      There were 112 (43%) FQHC medical directors or surrogates who responded to the 2016 survey. Overall, 41% of respondents were aware of a lung cancer screening program within 30 miles of their system’s largest clinic. Although 43% reported that some providers in their system offer screening, it was typically at a very low volume (less than ten/month). Although FQHCs are required to collect tobacco use data, only 13% indicated that these data can identify patients eligible for screening. Many FQHCs reported important patient financial barriers for screening, including lack of insurance (72%), preauthorization requirements (58%), and out-of-pocket cost burdens for follow-up procedures (73%). Only 51% indicated having adequate access to specialty providers to manage abnormal findings, and few reported that leadership had either committed resources to lung cancer screening (12%) or prioritized lung cancer screening (12%).

      Conclusions

      FQHCs and other safety-net clinics, which predominantly serve low-socioeconomic populations with high proportions of smokers eligible for lung cancer screening, face significant economic and resource challenges to implementing lung cancer screening. Although these vulnerable patients are at increased risk for lung cancer, reducing patient financial burdens and appropriately managing abnormal findings are critical to ensure that offering screening does not inadvertently lead to harm and increase disparities.
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