Systemic Challenges to Lung Cancer Screening in the Safety-Net Setting: Care and Informatics Fragmentation.

[BACKGROUND] Despite being the leading cause of cancer death, <20% of eligible, at-risk Americans undergo lung cancer screening. Lung cancer risk is concentrated in lower-income populations, but Medicaid-insured populations consistently have the lowest screening rates across cancers. To improve lung cancer screening rates and outcomes, we must understand the systemic challenges of orchestrating a complete episode of multidisciplinary care, from radiographic screening to treatment, in the resource-limited, safety-net environment.

[METHODS] We performed a qualitative case study of purposively sampled imaging-based cancer screening programs in safety-net organizations serving high-need populations in Los Angeles County, identified by geospatial techniques. Using a semistructured guide, organizational screening experts were prompted in hour-long telephone interviews between November 28, 2023, and February 12, 2024, to describe their organization's imaging-based "screening pipeline," including how they interfaced with external organizations to complete multidisciplinary screening to treatment. Audio was securely recorded, transcribed, and analyzed, using inductive thematic analysis.

[RESULTS] Four diverse organizations provided insight. Respondents highlighted two main resource-intensive systemic challenges: (1) fragmentation of care across multiple organizations and (2) siloed health information, particularly imaging. These interrelated challenges precluded simplification or automation of screening processes, prompting organizations to resort to manual, labor-intensive workarounds to partially overcome these systemic issues.

[CONCLUSION] Care and informatics fragmentation particularly deplete safety-net resources and cause organized cancer screening programs to be unduly labor-intensive in this setting. These challenges were prevalent even in well-established screening programs, like breast, reinforcing that comprehensive, equity-based screening solutions transcend individual organizations.