What type of study is this?

This is a Qualitative Study study.

What question did this study set out to answer?

The research aims to enhance lung cancer screening by encouraging at-risk patients to identify themselves for testing.

January 10, 2026Academic Radiology0 citations

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Improving Lung Cancer Screening at a Safety-Net Hospital: Empowering At-risk Patients Through Self-identification

CAChristian Ashby-PadialBoston Medical Center PSPaul SherbanBoston University HRHailey RichBoston University

Key Points

The research aims to enhance lung cancer screening by encouraging at-risk patients to identify themselves for testing.
Implemented a self-identification program for at-risk patients at a safety-net hospital.

Structured PICO

Does a brief smoking-history questionnaire in radiology waiting areas improve lung cancer screening uptake in a safety-net hospital?

Population

6,160 patients arriving for imaging appointments at a safety-net hospital who completed a voluntary smoking history questionnaire

Intervention

Brief, multilingual smoking-history questionnaire administered in radiology waiting areas to identify lung cancer screening eligibility and notify primary care providers

Outcome

Feasibility of identifying lung cancer screening eligibility and standardizing notification to primary care providers (measured by response rate, eligibility identification, and subsequent screening orders)

While a waiting-room questionnaire can feasibly identify patients eligible for lung cancer screening, subsequent screening rates remain low, highlighting systemic barriers in safety-net settings.

Abstract

RATIONALE AND OBJECTIVES Lung cancer screening (LCS) with low-dose computed tomography (LDCT) reduces lung cancer mortality by 20% and all-cause mortality by 6.7%. In 2013, the United States Preventive Services Task Force (USPSTF) recommended LCS with LDCT for adults aged 55-80 with a ≥30 pack-year smoking history who currently smoke or quit within the past 15 years. In 2021, these recommendations grew to include more at-risk populations by lowering the screening age to 50 years and reducing the smoking history threshold to 20 pack-years. We assessed the feasibility of a brief, multilingual smoking-history questionnaire in radiology waiting areas to identify LCS eligibility and standardize notification to primary care providers (PCPs) in a safety-net hospital. MATERIALS AND METHODS Quality improvement initiative, exempt from formal IRB review and the requirement for informed consent. Over an 18-month period between 2021 and 2024, we administered a voluntary smoking history questionnaire assessing demographics, lung cancer risk, LCS eligibility, and relevant medical and family history to all patients arriving for imaging appointments. RESULTS From an estimated total of 54,000 surveys distributed, 6160 questionnaires were collected (11.4% response rate), and 373 patients (6.0%) self-identified as eligible for LCS based on either 2013 or 2021 USPSTF criteria. Among these patients, 202 (54.2%) were not currently undergoing LCS. Following PCP notification of their patients' LCS eligibility, only 19 of the 202 patients (9.4%) subsequently had baseline LCS exams ordered. These proportions reflect feasibility/process and are not evidence of effectiveness. CONCLUSION A brief, multilingual smoking-history questionnaire in radiology waiting areas in a safety-net setting was feasible to implement. LCS rates remain low despite patient self-identification of LCS eligibility and PCP notification. This low uptake highlights the challenges of LCS and may reflect patient, healthcare provider, and systems-level barriers faced by patients in safety-net hospitals, such as financial constraints and limited healthcare access.

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Improving Lung Cancer Screening at a Safety-Net Hospital: Empowering At-risk Patients Through Self-identification

Key Points

Structured PICO

Abstract

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