Successes and challenges of implementing a lung cancer screeningprogram in federally qualified health centers: a qualitative analysis using theConsolidated Framework for Implementation Research

摘要

In recent years, studies have shown that low-dose computed tomography (LDCT) is asafe and effective way to screen high-risk adults for lung cancer. Despite this,uptake remains low, especially in limited-resource settings. The American CancerSociety (ACS) partnered with two federally qualified health centers andaccredited screening facilities on a 2 year pilot project to implement an LDCTscreening program. Both sites attempted to develop a referral program and carecoordination practices to move patients through the screening continuum andidentify critical facilitators and barriers to implementation. Evaluatorsconducted key informant interviews (N = 46) with clinical andadministrative staff, as well as regional ACS staff during annual site visits.The Consolidated Framework for Implementation Research guided our analysis offactors associated with effective implementation and improved screeningoutcomes. One study site established a sustainable lung screening program, whilethe other struggled to overcome significant implementation barriers. Increasedtime spent with patients, disruption to normal workflows, and Medicaidreimbursement policies presented challenges at both sites. Supportive, engagedleaders and knowledgeable champions who provided clear implementation guidanceimproved staff engagement and were able to train, guide, and motivate staffthroughout the intervention. A slow, stepwise implementation process allowed onesite’s project champions to pilot test new processes and resolve issuesbefore scaling up. This pilot study provides critical insights into thenecessary resources and steps for successful lung cancer screening programimplementation in underserved settings. Future efforts can build upon thesefindings and identify and address possible facilitators and barriers toscreening program implementation.