# Digital Health Implementation Strategies to Improve Lung Cancer Screening Among Safety-Net Clinics

> **NIH ALLCDC U48** · UTAH STATE HIGHER EDUCATION SYSTEM--UNIVERSITY OF UTAH · 2024 · $299,998

## Abstract

ABSTRACT
Lung cancer is the leading cause of cancer-related mortality in the U.S., accounting for approximately 1 in 5
cancer-related deaths. Approximately 80% of lung cancers are attributable to cigarette smoking. Annual Low-
Dose Computed Tomography screening for lung cancer (hereafter referred to as Lung Cancer Screening or LCS)
is recommended by the U.S. Preventive Services Task Force (USPSTF). Despite evidence of effectiveness and
the USPSTF recommendations, implementation of LCS into clinical practice has been exceedingly limited, with
only 6.5% of eligible individuals screened in 2020, and there are major health inequities in LCS related to
race/ethnicity and socioeconomic status. The long-term goal of this program of research is to increase the
reach of LCS among low resource healthcare settings and populations that have been historically marginalized.
The proposed project, LUNG-IS, is a mixed-methods, pre-post quasi-experimental design conducted in three
Utah safety-net healthcare system “Free Clinics.” LUNG-IS will establish partnerships with one free clinic per
year for first 3 years of the project, and in the first year will collaborate with a nonprofit, no-cost, Free Clinic
that provides high-quality, multi-disciplinary healthcare to 3,018 uinsured patients annually, 97% of whom are
≤200% of the Federal Poverty Level (FPL), 65% are ≤100%, 88% are Latino. LUNG-IS leverages existing
pathways to care and Centralized Hub infrastructure that enables eligibility assessment, LCS shared decision
making (SDM) with clinical decision support, screening referral, and screening logistics assistance to help
overcome numerous social determinants of health that impact low resource settings and historically
marginalized populations. The Centralized Hub model uses ubiquitous technologies (i.e., text
messaging/telehealth) to enable safety-net patients to be assessed for LCS eligibility, engage in SDM if eligible,
and be referred for LCS. For patients who decide to complete LCS, they will be provided patient navigation via
Community Health Workers designed to address logistical barriers, hesitancy, and financial constraints around
completing LCS. The specific aims are to 1) evaluate the impact of implementation strategies on LCS eligibility
screening, SDM completion, and LCS completion, 2) characterize multi-level factors that influence
implementation and effectiveness outcomes, and 3) identify and classify adaptations to implementation
strategies that occur throughout the study.

## Key facts

- **NIH application ID:** 11048877
- **Project number:** 1U48DP006855-01
- **Recipient organization:** UTAH STATE HIGHER EDUCATION SYSTEM--UNIVERSITY OF UTAH
- **Principal Investigator:** PAUL ESTABROOKS
- **Activity code:** U48 (R01, R21, SBIR, etc.)
- **Funding institute:** ALLCDC
- **Fiscal year:** 2024
- **Award amount:** $299,998
- **Award type:** 1
- **Project period:** 2024-09-30 → 2029-09-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11048877

## Citation

> US National Institutes of Health, RePORTER application 11048877, Digital Health Implementation Strategies to Improve Lung Cancer Screening Among Safety-Net Clinics (1U48DP006855-01). Retrieved via MORVS 2026-10-25 from https://api.morvs.ai/grant/nih/11048877. Licensed CC0.

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