Abstract
Rationale: The majority of eligible people have not been screened for lung cancer. There is emerging evidence that there are location-based disparities applicable to lung cancer screening (LCS). Objectives: To describe LCS radiologic services in rural Oregon and understand the barriers and facilitators to implementation of LCS using low-dose computed tomography (LDCT). Methods: This was a mixed-method descriptive study using surveys and semistructured interviews of key informants. We approached representatives from all 37 small and rural hospitals in Oregon. We purposively interviewed key informants from a subset based on LDCT implementation outcomes. Results: We surveyed representatives from 29 radiology facilities and qualitatively interviewed 18 key informants from 19 facilities (representing 12 healthcare systems). Among the surveyed radiology facilities, 59% were performing LDCT for LCS. Key informants reported that facilities that performed this service were often motivated by community needs and were less motivated by financial gain or evidence strength, and all described the importance of having a champion. Key informants described that LCS programmatic components that were within their normal scope of practice (e.g., specifying the LDCT parameters) were burdensome to establish but that barriers were surmountable. Most informants reported they did not perform other components of high-quality programs (e.g., ensuring adherence to recommended follow-up testing) and suggested that these steps were important but were the responsibility of primary care providers. Conclusions: Many rural hospital facilities in Oregon offer LDCT for LCS but do not perform all the recommended components of a screening program. Disparities in LCS use and adherence are unlikely to be solved by an exclusive focus at the radiology facility level and may require additional interventions at the primary care level.