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PPO 22-161 – HSR Study

PPO 22-161
Co-Design and Pilot Testing of Peer-led Community Outreach to Improve Equity, Veteran-Centeredness and Uptake of Lung Cancer Screening
Renda Soylemez Wiener, MD MPH
VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA
Boston, MA
Funding Period: January 2024 - June 2025


Background: Lung cancer screening (LCS) with annual computed tomography can reduce lung cancer mortality, but <10% of the estimated 1 million eligible Veterans have been screened, with lower rates among Black people. Many barriers prevent Black people from engaging in LCS: lack of awareness of LCS or how to access it, stigma, fatalistic expectations about lung cancer, power differentials with providers, mistrust of VA, limited self-efficacy, and adverse social determinants of health [entrenched by structural racism]. As a result, across the US LCS uptake is 50% lower [and adherence is 20% lower] among Black vs white persons. Significance: Fourteen Veterans die of lung cancer each day (5000/year), and Black men have the highest incidence and mortality in the US. To improve equity, the 2022 President’s Cancer Panel recommends using trained community peers (known in VA as Peer Specialists, or “Peers”) to reach vulnerable individuals where they are and support them in engaging in cancer screening. Our overarching hypothesis for this line of research is that community outreach, education, and tailored one-to-one support delivered by Veteran Peers can address barriers that prevent Black Veterans from accessing LCS, thereby closing disparities. Innovation & Impact: We will use co-design with Black Veterans, Peers, and community partners to develop an innovative, Veteran-centered intervention (Peer-led program) that meets the needs of Black Veterans. No prior research has tested VA Peer Specialists in such a role. This work is tightly aligned with Office of Research & Development priorities on health equity and precision oncology. The 2022 HSR&D priorities call for health equity studies and for pilot studies testing strategies for Veteran and community engagement. Specific Aims: This pilot project has the following aims: 1) Co-design the Peer-led program in partnership with Veterans and community stakeholders; 2) Assess feasibility and acceptability of the Peer-led program; and 3) [Establish feasibility of study procedures]. Methodology: In Aim 1, we will convene a virtual co-design team of 1-2 Peers and 5-7 Black LCS-eligible Veterans from across the US, [including at least 2 Black women and Veterans varying in age, ethnicity, and geographic residence. Using best practices for equity-centered co-design], we will create a plan and messages for community outreach, content for group LCS orientation, and the process for one-to-one Peer coaching and navigation to support Black Veterans to engage in LCS. We will seek input from our community partners, [the National Association for Black Veterans and Tri-Ad Veterans League], external Veteran advisory panels, and LCS clinical staff to ensure relatability beyond our team and fit with clinical workflow. In Aim 2, we will conduct a feasibility pilot test of the Peer-led program. The Peer will lead up to 4 group LCS orientations in community partner sites to reach ~40 LCS-eligible Black Veterans. The Peer will provide one-to-one tailored support to 15 Veterans (e.g., coaching, goal-setting, navigation to access VA LCS). We will evaluate program delivery with Peer periodic reflections and activity logs. We will interview Veteran participants, community partners, and LCS clinical staff to explore feasibility and acceptability of the Peer-led program and solicit suggestions for improvement. Aim 3 will pilot test and refine study procedures to be used in the IIR: enrolling Veterans; administering surveys to assess change in Social Cognitive Theory constructs; and extracting LCS uptake and tobacco treatment 3 months post-enrollment from VA’s Corporate Data Warehouse. Next Steps/Implementation: This work will inform a multi-site stepped-wedge trial (IIR) to assess effectiveness, implementation, and cost of the Peer-led program in VA LCS sites and neighboring [branches of the National Association for Black Veterans]. Our operational partners in the National Center for Lung Cancer Screening, Office of Health Equity, and Peer Specialist Services are committed to disseminate the Peer-led program to reduce disparities in LCS and lung cancer outcomes, in line with VA’s 2022-28 Strategic Plan.

External Links for this Project

NIH Reporter

Grant Number: I21HX003712-01A1

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None at this time.

DRA: Cancer
DRE: Prognosis, TRL - Applied/Translational
Keywords: Cancer, Disparities
MeSH Terms: None at this time.

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