A Community Health Worker Intervention to Improve Lung Cancer Screening Uptake in Community Health Centers

Counts abstracted from the study screening and enrollment log at each of the following stages: approached, screened eligible, consented, randomized, completed baseline data collection, and completed post-intervention follow-up assessment.

Percentages calculated from the study screening and enrollment log. Eligibility rate = number screened eligible divided by number approached. Consent rate = number consented divided by number screened eligible. Randomization rate = number randomized divided by number consented. Baseline completion rate = number completing baseline data collection divided by number randomized. Retention rate = number completing post-intervention follow-up divided by number randomized.

Time in minutes spent on SDM, recorded by community health workers (CHWs) in the encounter/call tracking log.

Time in minutes spent on smoking cessation counseling,recorded by community health workers (CHWs) in the encounter/call tracking log.

Mean total score on the OPTION Scale Observer OPTION Scale scored from audio-recorded SDM encounters; 12 items rated 0 ("not observed") to 4 ("exhibited at a very high standard"), total score 0-48, with higher scores indicating greater SDM competence.

Mean count of CMS SDM Elements completed during each encounter: reduced lung cancer mortality, false positive, overdiagnosis, radiation exposure, annual screening, smoking cessation, follow-up testing, and diagnostic procedures.

Proportion of participants for whom the SDM decision aid was used, documented in the CHW encounter log.

Proportion referred to any tobacco treatment service by type (telephone quitline, in-person counseling,), from EHR referral orders and the CHW encounter log.

Qualitative themes regarding overall experience with the CHW intervention and barriers to lung cancer screening, identified through thematic analyses of semi-structured interviews using a study-specific interview guide. Participants (N=15), ~40-45 minutes, conducted in private at 3-month follow-up;

Qualitative themes regarding overall experience with the CHW intervention and barriers to lung cancer screening, identified through thematic analysis of CHW encounter logs and semi-structured interviews using a study-specific interview guide. CHWs (N=3), one 45-minute interview each after final intervention delivery.

Proportion of participants with an order placed in the electronic health record referring them to the LCS program, abstracted from EHR order data. Reported overall and by ordering source (community health worker vs. primary care provider).

Proportion of participants with a completed low-dose CT scan documented in the electronic health record, ascertained by EHR chart abstraction

Proportion of participants initiating any tobacco treatment, and proportion by type (telephone quitline, in-person counseling, nicotine replacement therapy, prescription pharmacotherapy), ascertained by EHR chart abstraction and participant self-report at follow-up.

Number of weeks of continuous tobacco treatment received, calculated from EHR pharmacy fill and counseling encounter data supplemented by participant self-report.

Count of quit attempts lasting at least 24 hours, measured by participant self-report at the 3-month follow-up assessment.

The Lung Cancer Screening Knowledge Measure (published as "a brief measure of smokers' knowledge of lung cancer screening with low-dose computed tomography") is a 12-item instrument assessing knowledge of lung cancer screening eligibility, benefits, and harms. One point is awarded per correct response. Total score ranges from 0 (minimum) to 12 (maximum). Higher scores indicate greater knowledge and are a better outcome.

The Lung Cancer Screening Health Belief Scales are a 35-item instrument based on the Expanded Health Belief Model. The Perceived Risk of Lung Cancer subscale comprises 3 items rated on a 4-point Likert scale from 1 (strongly disagree) to 4 (strongly agree). The subscale score is the mean of the item responses and ranges from 1 (minimum) to 4 (maximum). Higher scores indicate greater perceived personal risk of lung cancer. This construct is not inherently better or worse; higher perceived risk is hypothesized to be associated with greater screening uptake.

The Perceived Benefits subscale comprises 6 items rated on a 4-point Likert scale from 1 (strongly disagree) to 4 (strongly agree). The subscale score is the mean of the item responses and ranges from 1 (minimum) to 4 (maximum). Higher scores indicate greater perceived benefit of lung cancer screening and are a better outcome.

The Perceived Barriers subscale comprises 17 items rated on a 4-point Likert scale from 1 (strongly disagree) to 4 (strongly agree). The subscale score is the mean of the item responses and ranges from 1 (minimum) to 4 (maximum). Higher scores indicate greater perceived barriers to lung cancer screening and are a worse outcome.

The Self-Efficacy subscale comprises 9 items rated on a 4-point Likert scale from 1 (strongly disagree) to 4 (strongly agree), assessing patient confidence in the ability to arrange and complete lung cancer screening. The subscale score is the mean of the item responses and ranges from 1 (minimum) to 4 (maximum). Higher scores indicate greater self-efficacy and are a better outcome.

Trust in Navigator Scale: 6-item instrument developed to measure interpersonal trust in a patient's navigator (i.e., the CHW), adapted from the trust in physician scale. Items are rated on a 5-point Likert scale. The score is the mean of the 6 item responses and ranges from 1 (minimum) to 5 (maximum) with higher mean scores indicating greater trust.

The Shared Decision Making Process Scale (also referred to as the SDM Process Survey; National Quality Forum measure 2962) is a 4-item patient-reported instrument assessing whether the clinical conversation addressed the benefits of the option, addressed the harms of the option, and elicited the patient's preference. Total score ranges from 0 (minimum) to 4 (maximum). Higher scores indicate a more complete shared decision making process and are a better outcome.