Collaborative Intervention for Lung Cancer Screening May Improve Health Equity Among People with Serious Mental Illness

A collaborative approach to lung cancer screening involving a tailored educational intervention may improve health equity for individuals with serious mental illness, a new study found.

The study, published in the Journal of the American College of Radiology, involved mental health, primary care and radiology clinicians collaborating on a person-centered lung cancer screening education intervention for patients with schizophrenia and bipolar disorder. 

“Usual care models are not working for all patient populations, and we have to transform our patient care delivery to develop collaborative, team-based approaches to deliver equitable care that is person-centered and responsive to the needs and capacities of the diverse populations we serve,” lead author Dr. Efrén J. Flores, MD, assistant professor of radiology at Harvard Medical School and a radiologist at Massachusetts General Hospital, told Diagnostic Imaging. “This publication serves as an example of how we can break silos across specialties and collaborate with primary care and mental health clinicians to advance equity in lung cancer screening.”

The study included patients spread across more than 30 practices who all met at a community mental health clinic for psychiatric care, smoking cessation and health maintenance counseling. Eligible patients ages 55 to 77 were recruited into the study between April and October 2019. All participants lacked a guardian to help with medical decisions and had a history of smoking, diagnosis of schizophrenia or bipolar disorder, and capacity to consent and complete a survey.

Investigators conducted 3 focus groups with mental health, primary care and radiology clinicians and tailored the educational intervention. The mental health clinician introduced study staff and assisted with enrollment of the patients.

The two-part intervention included a video explaining what to expect during the lung cancer screening and an educational session to discuss the risks of lung cancer and smoking. Among 30 eligible patients, 15 (50%) enrolled in the lung cancer screening intervention, all 15 completed the intervention and 14 of the 15 (93%) were satisfied with the intervention. The investigators assessed feasibility as greater than 50% enrollment and 75% completion and acceptability as greater than 75%.

“My biggest surprise was the openness of everyone involved in the study (patients, mental health clinicians, community mental health clinic leadership) to collaborate with a radiologist on this study,” Flores said. “This study is driven by a health equity mission and is imperative that we all collaborate, as it takes all of us to assist our patients overcome barriers to care and take meaningful steps towards achieving health equity in lung cancer outcomes through early detection.”

Efforts to improve lung cancer screening among individuals with severe mental illness could improve health equity for this patient population, which is 2 to 4 times more likely to die of lung cancer, the study authors noted. In general, efforts to increase lung cancer screening have contributed to an increase in the five-year survival rate by 13.1 percent over the past five years. Additionally, the American College of Chest Physicians recently published new evidence-based guidance for low-dose CT for lung cancer screening with 16 recommendations.

Limitations of the study include its small sample size at a single center. Flores said work will continue to expand collaborative efforts to benefit patients in other clinics.

“We should be investing efforts and our energy in tailoring our care delivery to better serve all patient populations, and that we can do it together to build sustainable models that are scalable across systems,” Flores said. “We should make efforts to move from stigmatizing language that perpetuates health disparities like ‘hard to reach populations’ and focus our efforts in enhancing our care by increasing access and designing new care pathways that maximize each patient encounter. In this case, this frequent touch point with the healthcare system was in the community mental health clinic and we want to leverage this opportunity to offer patients additional services at their convenience.”