Rural barriers and facilitators of lung cancer screening program implementation in the veterans health administration: a qualitative study

Frontiers in Health Services

Health Services

Carolyn M. Audet¹  Sunil Kripalani²  Timothy J. Vogus³  Christopher J. Lindsell⁴  David G. Schlundt⁵  Kemberlee Bonnet⁵  David F. Yankelevitz⁶  Claudia I. Henschke⁷  Fred Hendler⁸  Christianne L. Roumie⁹  Lucy B. Spalluto^1,10  Robert S. Dittus^1,11  Susan Byerly^1,11  Jennifer A. Lewis^1,12  Sally J. York^1,13  Drew Moghanaki^1,14 

[1] Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, United States;Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, United States;Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, United States;Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States;Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, United States;Owen Graduate School of Management, Vanderbilt University, Nashville, TN, United States;Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, United States;Department of Psychology, Vanderbilt University, Nashville, TN, United States;Qualitative Research Core, Vanderbilt University Medical Center, Nashville, TN, United States;Department of Radiology, Icahn School of Medicine at Mount Sinai, NY, New York, United States;Department of Radiology, Icahn School of Medicine at Mount Sinai, NY, New York, United States;Veterans Health Administration—Phoenix VA Health Care System, Radiology Service, Phoenix, AZ, United States;Rex Robley VA Medical Center, Medicine Service, Louisville, KY, United States;Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, United States;Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, United States;Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States;Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, United States;Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, United States;Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, United States;Vanderbilt-Ingram Cancer Center, Nashville, TN, United States;Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, United States;Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, United States;Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States;Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, United States;Veterans Health Administration-Tennessee Valley Healthcare System, Medicine Service, Nashville, TN, United States;Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States;Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, United States;Vanderbilt-Ingram Cancer Center, Nashville, TN, United States;Veterans Health Administration-Tennessee Valley Healthcare System, Medicine Service, Nashville, TN, United States;Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States;Vanderbilt-Ingram Cancer Center, Nashville, TN, United States;Veterans Health Administration—Greater Los Angeles Veterans Affairs Medical Center, Radiation Oncology Service, Los Angeles, CA, United States;Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, United States;

关键词: lung cancer screening;    barriers;    facilitators;    implementation science;    low-dose CT;    RE-AIM;    rural;   

DOI  :  10.3389/frhs.2023.1209720

 received in 2023-04-21, accepted in 2023-08-04,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionTo assess healthcare professionals' perceptions of rural barriers and facilitators of lung cancer screening program implementation in a Veterans Health Administration (VHA) setting through a series of one-on-one interviews with healthcare team members.MethodsBased on measures developed using Reach Effectiveness Adoption Implementation Maintenance (RE-AIM), we conducted a cross-sectional qualitative study consisting of one-on-one semi-structured telephone interviews with VHA healthcare team members at 10 Veterans Affairs medical centers (VAMCs) between December 2020 and September 2021. An iterative inductive and deductive approach was used for qualitative analysis of interview data, resulting in the development of a conceptual model to depict rural barriers and facilitators of lung cancer screening program implementation.ResultsA total of 30 interviews were completed among staff, providers, and lung cancer screening program directors and a conceptual model of rural barriers and facilitators of lung cancer screening program implementation was developed. Major themes were categorized within institutional and patient environments. Within the institutional environment, participants identified systems-level (patient communication, resource availability, workload), provider-level (attitudes and beliefs, knowledge, skills and capabilities), and external (regional and national networks, incentives) barriers to and facilitators of lung cancer screening program implementation. Within the patient environment, participants revealed patient-level (modifiable vulnerabilities) barriers and facilitators as well as ecological modifiers (community) that influence screening behavior.DiscussionUnderstanding rural barriers to and facilitators of lung cancer screening program implementation as perceived by healthcare team members points to opportunities and approaches for improving lung cancer screening reach, implementation and effectiveness in VHA rural settings.

【 授权许可】

Unknown   
© 2023 Lewis, Bonnet, Schlundt, Byerly, Lindsell, Henschke, Yankelevitz, York, Hendler, Dittus, Vogus, Kripalani, Moghanaki, Audet, Roumie and Spalluto.