D12-02 Bridging the Implementation Gap for Lung Cancer Screening in Underserved Alabama Communities

Abstract Rationale Lung cancer screening (LCS) uptake remains low in Alabama, a state with one of the highest U.S. lung cancer mortality rates where individuals face significant barriers to preventive care. Three NCI-funded studies (U54, CARA, LATTICE) have independently examined barriers, facilitators, and solutions among diverse Alabamians (primary care physicians, pulmonologists, residents, patients, and community advisory board members). This synthesis identifies implementation strategies for increasing LCS using low-dose CT (LDCT). Methods Three-stage qualitative analysis was conducted: (a)Thematic analysis inductively identified implementation strategies from 40 coded stakeholder statements. (b) Directed content analysis mapped each strategy to primary constructs in the Consolidated Framework for Implementation Research (CFIR) and dimensions of the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. (c) Strategies were then deductively aligned with discrete strategies from the Expert Recommendations for Implementing Change (ERIC) to support actionable planning.Participants: Data was collected from 68 stakeholders. U54 included 6 physicians and 15 screened patients from an academic medical center (AMC). CLARA comprised of screen-eligible individuals residing in persistent poverty tracts (N = 42). LATTICE comprised of Community Advisory Board (CAB) members (N = 5) with general familiarity of lung cancer, and/or representation from the Black community. Results We identified 15 discrete implementation strategies from 68 Alabama stakeholders, mapped to RE-AIM, CFIR, and ERIC. a)Reach (RE-AIM) addressed Outer Setting barriers (CFIR) via Adapt & Tailor tactics (ERIC): 5 strategies: mobile LDCT units, satellite clinics, weekend sessions, transportation support (Uber/bus passes), and integration with mammography or FQHC smoking cessation programs. b)Effectiveness (RE-AIM) leveraged Process - Engaging (CFIR) with Support Clinicians & Consumers tactics (ERIC): 3 strategies: empathetic, hope-based education, success stories, and Spanish materials and community outreach at churches to reduce stigma and prompt self-advocacy. c)Adoption (RE-AIM) targeted Inner Setting and Individual factors (CFIR) through Support Clinicians tactics (ERIC): 4 strategies: EMR prompts, pack-year calculators, staff training on smoking history, and shared decision-making billing education. d)Implementation (RE-AIM) ensured fidelity via Process - Planning & Executing (CFIR) and Use Evaluative Strategies (ERIC): 2 strategies: standardized care with centralized nodule clinics and 30/60/90-day reminder systems. e)Maintenance (RE-AIM) sustained engagement through Networks & Communications (CFIR) using Engage Consumers tactics (ERIC): 1 strategy: peer-to-peer specialist outreach. Conclusion This synthesis elevates Alabama stakeholder voices into a tiered implementation science model for LCS. The RE-AIM→CFIR→ERIC framework integration ensures strategies are systematically measurable and scalable. These strategies are critical for building a scalable lung cancer screening program in a southeastern U.S. region where such efforts remain critically underdeveloped. This abstract is funded by: NCI