Evidence-based interventions to effectively decrease preventable disease, disability and death caused by tobacco use are much needed in Tarrant and surrounding counties. Within the proposed service area, approximately 15% of residents between the ages of 55 and 74 reported being active smokers. The rates of lung cancer incidence for the service region is 61 per 100,000 residents, exceeding that for the state of Texas at 54.8 per 100,000. Similarly, mortality rate is also higher for the service region than the overall Texas rate at 44.9 compared to 40.4 per 100,000.

Lung cancer screening and tobacco cessation programming for the service area is sparse, particularly for the prio...

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Evidence-based interventions to effectively decrease preventable disease, disability and death caused by tobacco use are much needed in Tarrant and surrounding counties. Within the proposed service area, approximately 15% of residents between the ages of 55 and 74 reported being active smokers. The rates of lung cancer incidence for the service region is 61 per 100,000 residents, exceeding that for the state of Texas at 54.8 per 100,000. Similarly, mortality rate is also higher for the service region than the overall Texas rate at 44.9 compared to 40.4 per 100,000.

Lung cancer screening and tobacco cessation programming for the service area is sparse, particularly for the priority population the project intends to serve. The target population includes apparently healthy patients age 55-74 who have at least a 30 pack-year smoking history and either currently smoke or have quit within the past 15 years. The program will provide clinical services to at least 2,500 eligible patients.

The most common barriers are specific to expenses, transportation, understanding the need for screening, and managing cancer-related feelings and fears, and will be addressed through nurse navigation, which utilize motivational interviewing, problem solving and goal setting to further encourage patient compliance. The nurse navigators will help patients assess, plan, and complete each step in the CT screening process through regular telephone contact, addressing barriers that may hinder the patient from complying with the established care plan, to decrease time to clinical resolution and if necessary, the start of treatment.

This proposed project will establish a comprehensive lung cancer screening and follow-up program, including tobacco cessation counseling and education, leveraging existing infrastructure and a successful county-tailored delivery model to ensure these services reach those communities disproportionately impacted by cancer, including low-income, uninsured or underinsured patients residing in rural and underserved counties across North Texas.

The components of the project are based on a successful delivery model used at Moncrief Cancer Institute and comprised of a) Outreach & Health Promotion to reach rural and underserved patients; b) Delivery & Navigation to guide them through comprehensive screening and follow-up care, including tobacco cessation education and counseling; and c) Centralized Reimbursement to fund clinical services through a shared funding model.

The proposed project will reach approximately 100,000 patients through coordinated education and outreach efforts, targeting screen-eligible patients as defined by the USPSTF. The program will provide clinical services to at least 2,500 screen-eligible patients. Navigation as part of the lung cancer screening program provides an opportunity to capitalize on a “teachable moment” for tobacco cessation, harnessing patient motivation, while providing evidence-based resources as well as provider referrals for pharmacotherapy interventions.

In addition to telephone-based counseling, tobacco cessation efforts will also include evidence-based print materials, and mini-clinics to be held on the mobile health unit. Here, smokers will have the opportunity to meet face-to-face with a certified navigator or using telemedicine, a licensed psychologist or mid-level provider, should additional care be required. Innovation:

The proposed program builds on previously CPRIT funded work, leveraging existing MCI screening and navigation infrastructure in combination with David Gerber’s research screening protocol. These combined resources will enable the program to facilitate the expansion of screening beyond a traditionally integrated urban safety-net system and into an open and yet virtually integrated safety-net system. This will be achieved in collaboration with an established network of community partners and further supported with the MCI custom-built mobile health unit.

The 18-wheeler coach houses two exam rooms outfitted with telemedicine capabilities, and can connect to providers both at MCI and UT Southwestern to facilitate shared decision-making consultations, as well as tobacco cessation counseling.

The proposed program is highly scalable. The centralized regional delivery model addresses fundamental access barriers to care and can be applied in both urban and rural areas. MCI is well-positioned to provide care across North Texas to an expanding service area, incorporating new counties as they demonstrate need. The project team will also be able to provide education and training for the core program components to similarly situated community-based organizations, in Texas or elsewhere, interested in collaborating with local partners to provide comprehensive lung cancer screening and follow-up care.

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