Lay Navigators Improve Lung Cancer Screening (LCS) Uptake in Asian Americans in a Large Integrated Health System

J. B.. Velotta¹, Z. Zhu², S. Martinez², R. Allison², I. Deng³, M. Peryer³, K. Burapachaisri⁴, A. Baskin⁵, L. C. Sakoda^2
1Kaiser Permanente Oakland Medical Center, UCSF Department of Surgery, Kaiser Permanente Bernard J. Tyson School of Medicine, Oakland, California ²Kaiser Permanente Division of Research, Pleasanton, California ³Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California ⁴University of California, San Francisco School of Medicine, San Francisco, California ⁵UCSF School of Medicine, San Francisco, California

Purpose: Lung cancer is the number one cause of death in Asian Americans. Our previous research showed lung cancer screening (LCS) adherence is worst in Asian Americans in a large integrated health system. This study evaluates if implementing a lay navigator into our LCS program can improve LCS referrals and uptake.

Methods: This large multicenter prospective cohort study between 8/1/23 and 6/30/2024 evaluated N=1000 Asian American participants who qualified for LCS based on the current 2021 United States Preventative Services Task Force (USPSTF) guidelines. Two groups were matched according to age, gender, smoking status, and primary language; N=500 passive outreach participants and N=500 active outreach participants. Passive outreach patients consisted of electronic communication only for LCS referral while active outreach patients had assistance from a lay navigator for the entire LCS referral process. Chi-square and fisher’s exact test were used to compare outcomes for the following four outcome measures between both groups using data pulled from electronic health records: 1) referral for LCS 2) Shared-Decision Making (SDM) visit completion 3) Low Dose CT scan order referrals 4) Low Dose CT scan completion. Incidences in outcome differences between both groups were stratified by gender, Asian ethnic origin, primary language, and health literacy.

Results: A total of N=1000 Asian American participants were contacted, consisting of electronic messaging only in the passive outreach group (N=500) versus a combination of all virtual messaging methods and lay navigator assistance in the active outreach group (N=500). Both passive and active outreach Asian American participants were evenly matched for age at index date, age groups, gender, recent smoking status, pack-years smoked, primary language, service region, and home facility (p < 0.9). Participants in the active outreach group (lay navigator assistance) compared to the passive outreach group had significantly improved LCS referrals (19% vs. 9.8%, p< 0.001), 20 minute SDM visit completions (9.0% vs. 5.0%, P< 0.013), and low dose CT scan order referrals (1.2% vs. 0%, p< 0.03). Low dose CT scan completion between both groups were insignificant, however continued follow-up is ongoing.

Conclusion: This is the first study to investigate barriers to LCS perceived by Asian Americans by deploying the assistance of lay navigators. Lay navigators significantly improve LCS referral and SDM visit completion in Asian Americans. Future studies are ongoing to explore patient satisfaction scores as it pertains to each outreach method.

Identify the source of the funding for this research project: Thoracic Surgery Foundation (TSF) AstraZeneca Reversing Health Disparities in Lung Cancer Research Award