Using Telehealth to Increase Lung Cancer Screening Referrals for At-Risk Veterans in Rural Communities
Background: At-risk rural veterans have low rates of lung cancer screening (LCS). This proof-of-principle quality improvement project aimed to determine whether a telehealth intervention would increase referrals for at-risk veterans living in the rural upper Midwest and attending a smoking cessation program to LCS with low-dose computed tomography (LDCT) of the chest.
Methods: Sixty-eight of 74 LCS-eligible rural veterans who self-enrolled in a smoking cessation program were contacted by telephone. Those who agreed to enroll in LCS were referred to LDCT and followed for 4 months. At the conclusion of the intervention, the number of referrals and screenings performed were tabulated. LDCT reports were reviewed and scored according to Lung CT Screening Reporting and Data System (Lung-RADS) version 1.1.
Results: Only 3 of 74 LCS-eligible veterans (4%) underwent LDCT before initiation of this telehealth intervention. By the conclusion of this 4-month project, 19 of 74 veterans (26%) underwent LDCT. Forty-one veterans were successfully contacted and 29 agreed to participate in LCS. Of those who agreed to participate, 19 underwent LDCT within 4 months. Of the veterans who received LDCT, 10 were diagnosed with Lung-RADS 1, 7 with Lung-RADS 2, 1 with Lung-RADS 3, and 1 with Lung-RADS 4B. Annual follow-up LDCT or referral for further evaluation were pursued in each case.
Conclusions: Collectively, these data suggest that telehealth intervention could increase referrals of at-risk rural veterans to a centralized LCS program at a regional US Department of Veterans Affairs medical facility.
Limitations
This was a small, single site project composed of predominantly White male rural veterans participating in a smoking cessation program associated with a VA facility.26,27 It is not clear whether similar outcomes would be observed in at-risk veterans who do not participate in a smoking cessation program or in more diverse communities. We were unable to contact 40% of LCS-eligible rural veterans by telephone. Twelve veterans reached by telephone declined to participate in LCS without providing a reason, and only 19 of 68 eligible veterans (28%) underwent LDCT screening during the 4-month telehealth intervention. The reasons underlying this overall low accrual rate and whether rural veterans prefer other means of personal communication regarding LCS were not determined. Lastly, generalizability of our initial observations to other veterans living in rural communities is limited because the project was conducted only in rural northern Wisconsin and the Upper Peninsula of Michigan.
Conclusions
At-risk rural veterans may be willing to participate in a centralized LCS program at a regional VA medical facility when contacted and coordinated using telehealth modalities. These findings offer support for future prospective, multisite, VA telehealth-based studies to be conducted in rural areas. The results of this project also suggest that telehealth intervention could increase referrals of at-risk rural veterans to the closest centralized LCS program located at a regional VA medical facility.
