My Research
In my current research program, I seek to understand ways to improve implementation of lung cancer screening with particular attention to health equity. We know that annual lung cancer screening with low dose chest CT is an effective tool to reduce lung cancer mortality among a subset of high risk current and former smokers. While screening holds great promise, there are several important concerns in the screening space including: low uptake of screening among eligible patients, lack of engagement among providers and patients in screening and follow-up, and a wide array of screening benefits and harms among eligible patients. My current research projects, funded by the National Cancer Institute, the American Lung Association, the American Thoracic Society and the Lungevity Foundation seek to improve the implementation of lung cancer screening in order to ensure patients derive maximal benefits and minimal harms from this service.
I highlight some of my key ongoing research projects and findings below.
For a full list of my research publications, please click here
Tailoring Screening shared decision making in persons living with hiv
People with HIV (PWH) have higher rates of smoking and an increased risk of lung cancer compared to other groups of patients. However, there is limited information on how to tailor screening care for this group. In this mixed-methods study, we seek to incorporate patient and provider input into a tailored decision making tool which we will then pilot among PWH who are eligible for screening.
Tailoring screening and smoking cessation for LGBTQ+ populations
LGBTQ+ Americans face discrimination within the healthcare system and face barriers to preventive care. This population is at increased risk for lung cancer given elevated smoking history in this group which likely reflects historic and ongoing trauma. Using a Community-Based Participatory Research Approach we will partner with local LGBTQ stakeholders to develop a longitudinal intervention to assist screen-eligible LGBTQ persons through the lung cancer screening process.
Implementation problems in lung cancer screening
The up-side? Primary care doctors and pulmonologists are interested in and believe in the benefits of lung cancer screening. The down-side? Both specialists may lack the knowledge and resources to conduct screening for the appropriate patients in their current healthcare setting. Interventions focused on key point-of-referral resources may improve screening referral. A simple and accessible point-of-referral decision aid such as the one found here shouldiscreen.com may be a start.
Our research also demonstrates poor adherence to follow-up screening, poor patient knowledge of screening and limited smoking cessation interventions in the screening setting. We can do better.
Assisting in smoking cessation and lung cancer screening in indigenous people in seattle (The ASSIST Study)
American Indians and Alaska Natives (AI/AN) have the highest rates of commercial tobacco use of any racial or ethnic groups in the US, and have high risk for lung cancer. The majority of AIANs (70%) live in urban environments and may face unique barriers to preventive healthcare. The goals of this study are to build and pilot a patient navigation program to help Seattle-based AIANs receive recommended lung cancer screening and smoking cessation care.