Lung Cancer Screening Navigation for Homeless People

Mass General Brigham

Status: Completed

Conditions: Homelessness; Lung Cancer; Tobacco Use

Treatments: Behavioral: Patient Navigation

Study type: Interventional

Funder types: Other

Identifiers

NCT04308226

RSG-17-157-01-CPPB (Other Grant/Funding Number)

2018P001344

Details and patient eligibility

About

The investigators will conduct a pragmatic clinical trial to test the effect of patient navigation on lung cancer screening (LCS) low-dose computed tomography (LDCT) completion among Boston Health Care for the Homeless Program (BHCHP) patients at increased risk for lung cancer. Patient navigation is a strategy for guiding individuals through complex health systems, and the investigators hypothesize that this may be a promising approach for helping homeless-experienced people overcome their unique barriers to obtaining LCS.

The investigators will aim to recruit 300 people to participate in this research study; 100 will be randomly assigned to arm 1 (usual care) and 200 will be randomly assigned to arm 2 (patient navigation). Randomization of participants will be stratified by smoking status, housing status, clinical site, and whether they have previously discussed LCS with their primary care provider (PCP) to ensure balance between study groups on these variables. People assigned to the usual care arm will be referred back to their PCP for further management. People assigned to the patient navigation arm will be given the chance to work with a LCS navigator. The navigator will assist participants and their PCPs with all aspects of the LCS process in addition to offering brief tobacco counseling for current smokers.

The primary aim of the trial is to determine-among homeless-experienced people who are eligible for LCS-the effect of patient navigation on 1) LCS LDCT completion at 6 months post-enrollment and 2) LCS LDCT completion at 6 months with diagnostic follow-up of abnormal results within 1 month of the recommended time frame. Study outcomes will be assessed by examining participant health records.

Following the intervention, qualitative interviews will be conducted with 40 participants and 10 BHCHP PCPs to better understand how the LCS process unfolds in the setting of homelessness, the ways in which the navigator facilitated this process, and opportunities for improving the navigation intervention for future use.

Enrollment: 261 patients

Sex: All

Ages: 55 to 77 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Currently or formerly homeless
• Have a 30 pack-year smoking history and have smoked within the past 15 years
• Have a Boston Health Care for the Homeless (BHCHP) primary care provider (PCP)
• Proficient in English, assessed with items asking about native language and self-reported comfort communicating in English among non-native speakers

Exclusion criteria

• Prior chest computed tomography (CT) imaging in the past 12 months
• Personal history of lung cancer, or current presentation with symptoms concerning for lung cancer (e.g. hemoptysis or unexplained weight loss of >15 lbs. in the past year)
• PCP is the principal investigator
• Inability to provide informed consent, assessed with knowledge questions about the material presented during the informed consent process that individuals must correctly answer before providing informed consent to participate

Trial design

Primary purpose: Screening

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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261 participants in 2 patient groups

Usual care without patient navigation

No Intervention group

Description:

Participants assigned to this arm will be given basic educational materials on general lung health and referred back to their primary care provider (PCP) for management as per usual practice.

Usual care with patient navigation

Experimental group

Description:

Participants assigned to this arm will be informed about lung cancer screening (LCS), provided educational materials on LCS and patient navigation, and offered access to an LCS navigator who will partner with participants and primary care providers (PCPs) to facilitate low-dose computed tomography (LDCT) completion and follow-up.

Treatment:

Behavioral: Patient Navigation