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Angela Meredith Criswell



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    MA 04 - Advocacy: Listen to the Patients (ID 655)

    • Event: WCLC 2017
    • Type: Mini Oral
    • Track: Patient Advocacy
    • Presentations: 1
    • Now Available
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      MA 04.11 - A Comprehensive Vision to Reduce Lung Cancer Stigma: Changing Cultural Perspectives on Lung Cancer (Now Available) (ID 9507)

      12:05 - 12:10  |  Presenting Author(s): Angela Meredith Criswell

      • Abstract
      • Presentation
      • Slides

      Background:
      Lung cancer stigma has wide-reaching effects and impacts treatment, quality of life, survival, societal attitudes, research funding, and advocacy efforts. Those affected by lung cancer commonly feel hopeless, isolated, reluctant to share their diagnosis in addition to feelings of guilt, shame, anxiety and depression. Stigma responses can hinder information seeking information related to treatment options and psychosocial support and, tragically, can cause delays in diagnosis and even refusal of treatment. Major pan-cancer organizations, those dedicated to all lung diseases as well as lung cancer-specific organizations conduct awareness raising campaigns designed to confront lung cancer stigma, all working in some measure to create a more compassionate and empathic environment for those at-risk and diagnosed. These efforts have not been coordinated and to date, no known comprehensive vision to address lung cancer stigma in its entirety has been developed.

      Method:
      HIV/AIDS and mental health advocates have devoted extensive efforts to developing coordinated stigma reduction plans. While not always applicable, their approaches can inform our efforts in lung cancer. To develop a comprehensive framework to address lung cancer stigma, a synthesis of relevant strategies used in other disease-states, a review of lung cancer stigma literature and exploration of the efforts of organizations and individuals from around the world was conducted.

      Result:
      Awareness-raising, myth-busting and public health advocacy are featured prominently in other stigma-reduction plans. Lung cancer, like HIV/AIDS and other smoking-related cancers, must also address nihilism from medical professionals and work to ensure non-judgmental discussions and compassionate treatment environments that explore appropriate treatment options become the norm. Founded on seven key areas of opportunity, the plan includes multiple areas of impact that need to be addressed. Included are suggested remediation methods and real-world examples from all over the globe to illustrate creative ways lung cancer stigma reduction can be approached. This comprehensive, multi-level, multi-pronged vision allows individuals, systems and organizations to find points of convergence and work collaboratively on addressing the stigma so closely associated with lung cancer.

      Conclusion:
      Through a comprehensive approach, lung cancer stigma can be reduced and ultimately eliminated. To initiate a global conversation and better unite the lung cancer community, we offer this unifying strategy to address lung cancer stigma. Through the menu of stigma-reduction strategies, we hope to spark conversation, collaboration, and convergence. Dedicated medical professionals, survivors, loved ones, advocacy organizations and others can use the vision to apply appropriate strategies in their regions/countries and work collaboratively toward this all-important goal.

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    P2.13 - Radiology/Staging/Screening (ID 714)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Radiology/Staging/Screening
    • Presentations: 2
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      P2.13-015 - The Primary Care Provider Role in the US Screening Context: Current Practices and Strategies for Physician Engagement (ID 10249)

      09:30 - 09:30  |  Presenting Author(s): Angela Meredith Criswell

      • Abstract

      Background:
      As lung cancer screening has become more mainstream in the US, increasing attention has been paid to appropriate referral and follow up to minimize harms. This has been particularly focused on community-based programs as concerns have been voiced about the dearth of RCT evidence to support screening implementation in that setting. In addition, with the release of the US Preventive Services Task Force (USPSTF) and Centers for Medicare/Medicaid Services (CMS) recommendations for screening, more of the decision-making has been shifted to the primary care community. Primary care providers (PCPs) are expected to increase awareness of screening with their high-risk patients, perform counseling and shared decision-making (SDM), and manage screening outcomes more than ever before.

      Method:
      In a sample of mostly hospital-based lung cancer screening programs, program managers completed an application update as required for their continued participation in a national network. The applications were completed between March-June 2017 and covered areas of requirement for the designation, including: eligibility criteria, screening protocols, smoking cessation resources, multidisciplinary team make-up, SDM, and results reporting. 222 health systems responded, which represents 473 individual health care facilities out of 549 facilities that received the application (an 86% response rate).

      Result:
      Regarding counseling and SDM – required by CMS prior to generation of a written order - 82% of respondents reported that patients accessed SDM via the PCP. However, the majority of these respondents also indicated that the patient accessed SDM via a member of the screening team in addition to the PCP. Academic programs were less likely to see screening patients who received SDM through the referring provider and screening team (59%) compared to community/non-academic programs where 75% of patients received SDM through a referring provider and the screening team. We also examined the make-up of multidisciplinary clinical teams. 36% of respondents reported primary care as a team member. This was more common with community/non-academic programs when compared to academic programs.

      Conclusion:
      Data collected from screening program self-reporting indicates interesting trends in how primary care is incorporated into the lung cancer screening process prior to the referral through shared decision-making and during the review of screening results through the multidisciplinary care team. With patient awareness of lung cancer screening still reported to be low and PCP awareness and buy-in for lung cancer screening still considered to be inconsistent, supporting the integration of primary care into the workflow may help increase uptake of screening in a high risk population.

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      P2.13-016 - Self-Reported Program Barriers to Increasing Lung Cancer Screening Rates in the US and Implications for the Screening Community (ID 10258)

      09:30 - 09:30  |  Presenting Author(s): Angela Meredith Criswell

      • Abstract

      Background:
      Despite approval and coverage for lung cancer screening in the US for a high-risk population, recent research indicates that screening rates are still far lower than anticipated. Jemal and Fedewa (2016) looked at rates during 2011-2015 and found only a 3.9% screening rate in the eligible population. While some of that low rate may be due to lack of insurance coverage in both private and Medicare populations during the bulk of the study time period, screening programs continue to report challenges that may be barriers to increasing screening rates even though it is covered by most insurance plans and Medicare.

      Method:
      In a network of mostly hospital-based lung cancer screening programs in the US, 152 programs representing both academic and community programs completed a survey on practices and statistics, achieving a 61% response rate. The survey was completed using SurveyMonkey between March-June 2017 and asked a range of questions based on the 2016 program experience, including program statistics, current smoking cessation referrals, participation in research and programmatic barriers. The reported data here represent screening program managers’ perceptions of continued challenges to screening as captured through two specific questions: “What barriers continued to cause problems for you in 2016?” and because insurance/billing issues constitute a broader category, “What was the nature of the insurance/billing issues you faced in 2016?”

      Result:
      The majority of respondents indicated that insurance/billing issues, lack of patient awareness, internal workflow challenges, and lack of support from referring providers were barriers that continued to cause problems in 2016. Only 30% of respondents indicated that lack of patient interest in screening was a barrier and 41% indicated that staffing/time limitations was a barrier. Other barriers identified by respondents included lack of provider awareness and challenges (often technical) with complying with the Medicare requirement for submission of registry data. Because insurance/billing issues continue to be significant, respondents provided more detail about the nature of these issues, including claims denials, coverage co-pays or deductibles, coding errors, and receiving prior authorizations.

      Conclusion:
      Despite widespread insurance coverage in the eligible screening population in the US, screening programs are still facing barriers to increasing screening service usage. It is clear that communities and professionals supportive of screening need to focus attention in increased patient and provider education around lung cancer screening. However, insurance and billing issues remain a major challenge, even though coverage is theoretically in place.

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    WS 01 - IASLC Supporting the Implementation of Quality Assured Global CT Screening Workshop (By Invitation Only) (ID 632)

    • Event: WCLC 2017
    • Type: Workshop
    • Track: Radiology/Staging/Screening
    • Presentations: 3
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      WS 01.06 - How Do We Engage the High Risk Population in Lung Cancer Screening? - Strategy for Engaging Participants (ID 10644)

      09:17 - 09:25  |  Presenting Author(s): Angela Meredith Criswell

      • Abstract
      • Slides

      Abstract:
      “If you build it, they will come.” This slogan represents an easy assumption that screening availability and/or coverage necessarily leads to screening uptake. But unlike the mystical ballplayers from Field of Dreams, those at high risk for lung cancer possess neither a preternatural awareness of nor attraction toward lung cancer screening. Lung Cancer Alliance (LCA) made early detection a core organizational priority a decade before widespread insurance coverage finally made screening accessible to those at high risk. At each step we advocated for the key building blocks--funding, research, and policymakers’ attention and decision-making--that made community-level screening implementation possible. Following the National Lung Screening Trial’s publication, LCA established the National Framework for Excellence in Lung Cancer Screening and Continuum of Care to prioritize the dissemination and implementation of best practices for safe and responsible screening and to help guide the transition to community-level screening. Likewise, recognizing the need for a timely public awareness strategy, LCA developed and launched the “Live More Moments” media campaign that encouraged people to know their lung cancer risk and learn more about early detection through screening. Additionally, the growing network of screening programs receiving LCA’s designation as a Screening Center of Excellence helped ensure those at high risk who chose to be screened could do so with a screening program committed to best practices. In the midst of this landmark movement toward increased public awareness of lung cancer risk and the right to responsible screening and care, the USPSTF released their “Grade B” recommendation and established screening as a covered preventive service for those meeting the specified high risk criteria. It is undeniable that efforts to increase public awareness of lung cancer screening are far more complex than other population-level prevention and early detection awareness strategies. There are distinct difficulties associated with identifying who is at high risk and targeting a message to them that is clear and easily understood and that compels them toward an action step in a responsible, patient-centered manner. Intensifying this difficulty are unique psychosocial barriers experienced by many of those at high risk for lung cancer: stigma from one’s smoking status or history, fear of the test and possible diagnosis, denial about one’s risk status or the benefits of early detection, and distrust or suspicion of the healthcare industry. Responsible lung cancer screening programs will clearly identify and communicate the criteria they use to determine whom they will screen. Many utilize CMS eligibility criteria while others screen the slightly broader age range recommended under USPSTF criteria, and some also include NCCN group 2 if the patient and referring provider have determined through a shared decision-making process that screening is appropriate. To facilitate and ease the patient engagement process, LCA has developed educational materials that can be used to help patients understand the process of lung cancer screening: what screening is; who should consider being screened; the benefits and risks of screening; and what to consider in choosing a high quality screening program; as well as a brochure addressing smoking cessation in the context of their screening decision. Drawing upon insights provided by recent research into psychosocial barriers to screening, we have begun development of educational materials and messaging to specifically address these barriers and have intensified ongoing efforts to address stigma in particular. Because the early detection benefit of lung cancer screening is realized through adherence to repeat annual screening as well as compliance with nodule follow-up, it is essential that screening participants are engaged in a process of shared decision making. This allows for their full and deliberate consideration of the benefits, risks and potential harms of lung cancer screening in the context of their own priorities and values, which likewise deepens their understanding of and commitment to screening as a process rather than a discrete test. In addition, improved patient and provider communication can lead to improved screening adherence. LCA has worked with the network of Screening Centers of Excellence to collect adherence-building best practices to compile and share with programs needing to increase their own return rates. In addition to addressing awareness, knowledge, beliefs and attitudes about screening, engagement strategies should also acknowledge and address logistical barriers to screening. While insurance coverage removes a tremendous cost barrier, continued billing and coding challenges result in unanticipated and often erroneous bills for patients. This creates a burden on both the patient and the screening program staff to correct the situation and may result in added distrust toward the screening process on the part of the patient. Screening programs need a strategy to identify and assist patients in these circumstances. And while most U.S. insurance plans must cover screening for eligible plan-holders without co-pays or cost-sharing, patients need to know ahead of time that follow-up testing may bring considerable cost. Distance and transportation are also potential logistical barriers. As the ranks of LCA’s more than 500 Screening Centers of Excellence continues to grow, more and more people at high risk for lung cancer will be able find a program committed high quality lung cancer screening in their local community. Additionally, the prospect of telehealth delivery of shared decision-making will help even more patients overcome access barriers and ease their engagement in the lung cancer screening process. References: Carter-Harris, L., Ceppa, D. P., Hanna, N. and Rawl, S. M. Lung cancer screening: what do long-term smokers know and believe? Health Expect. 2017; 20: 59–68. doi:10.1111/hex.12433 Carter-Harris, L., Gould, M. K., Multilevel Barriers to the Successful Implementation of Lung Cancer Screening: Why Does It Have to Be So Hard? Ann Am Thorac Soc. 2017; 14(8). doi:10.1513/AnnalsATS.201703-204PS Gressard, L. et al. A qualitative analysis of smokers’ perceptions about lung cancer screening. BMC Public Health. 2017; 17:589. doi 10.1186/s12889-017-4496-0 Peckham, J. Engaging Patients & Assisting Primary Care Physicians in Lung Cancer Screening. accc-cancer.org. Oncology Issues. July-Aug 2016: 31-35.

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      WS 01.21 - Session 4: The Concept of Collaboration in CT Screening Programs (ID 10659)

      13:25 - 13:25  |  Presenting Author(s): Angela Meredith Criswell

      • Abstract

      Abstract not provided

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      WS 01.39 - 1. How Do We Ensure Smoking Cessation is Integrated into Best Practice Screening? (ID 10684)

      18:00 - 18:00  |  Presenting Author(s): Angela Meredith Criswell

      • Abstract

      Abstract not provided