So my name is Efraim Flores, first I want to say thank you to all the panelists and committee of the World Cancer, World Congress on Lung Cancer and ISLC for inviting me to present here and join the amazing discussion today and the part of the CT Screening Symposium. So I'm going to focus my talk on community outreach and engagement and build up a little bit more on some of the topics touched on by my colleagues, these are my disclosures. So I'm going to start talking about like a patient that presented one of the days that I was on call, 54-year-old man with 35-year history, presented to the emergency room and mental status changes due to metastatic lung cancer. So if we think about the patient probably could have been saved by lung screening or at least it would have been earlier stage rather than presenting with advanced disease. That case highlights the importance of lung screening in terms of improving health outcome but it also highlighted the disparity that we see in lung cancer screening and the barriers that many patients face whether it could be associated to stigma, identifying who's truly eligible, unfamiliarity with the new guidelines, cost concerns among others. So it really have to be our work needs to be intentional in order for lung cancer to meet not only the population that needs it the most at high risk but also that is a similar part with colorectal, breast and cervical cancer among others. So there's a lot of work to be done but today's conversation is not going to be focused on barriers only. I wanted to focus and really move towards discussing solutions and how do we use barriers to inform programs that can address some of those barriers whether it could be identifying eligible patients, overcoming cultural barriers, community outreach, patient education among other things. So the first step and we saw earlier in this part of the discussion, two different patient populations getting impact and suffering from health disparity in lung cancer screening and lung cancer outcomes. And we have to first recognize that 80% of health outcomes are influenced by factors outside of the healthcare walls. So even if we optimize lung cancer screening and we do everything perfectly in the healthcare system we're only impacting that 20% because that 80% outside of the healthcare wall determines how patients engage. So it's up to us to not only understand but address those factors outside of the healthcare wall. So we think about not only recognizing that 80% of the healthcare factors, social determinants of health or health-related social needs which are the structural barrier, how they impact the individual specifically influence the entire lung cancer screening continuum from engaging and getting lung cancer screening to following up on abnormal results. Then we can use that information to inform how do we address these health-related social needs from developing rideshare programs, culturally sensitive or culturally concordant health information, addressing cost concerns among many other things. But the key component that we have to discuss in order for us to develop successful and sustainable programs is the need for community engagement to advance health equity in lung cancer screening. So we talk about patient-centered care and PCORI when they talk about nothing about or without us and the same thing has to be about the community. So who better to tell us about what works best in the community than the community themselves? So a way to gain the community perspective through community-based participatory research is a way to gain not only their perspective but also have meaningful conversations about some of the pressing topics that are part of the community and you do it in a way that is systematic and then you use anecdotal data to create that, scientific data that can guide the development of programs that are going to address that 80% for our patients. So this is an example of a project that we did funded by the National Academies of Medicine looking at current and emerging barriers to lung cancer screening among Latino patients. Where we found the focus group discussion were based on accessing care and lung cancer screening during COVID, telehealth and digital health barriers, lung cancer outreach preferences. And some of the quotes here from patients, providers, and community organization highlight three topics. One of trust, the other one about misinformation, and then the other one about the digital health divide. So if we use that information from the focus group, then you can guide the development of multi-level interventions that address the upstream factors or the 80% outside of the healthcare world, but also the downstream factor, what we're seeing within our healthcare system. So when we talk about building trust and addressing misinformation, I'll talk about some of the work that started during COVID pandemic when we were doing the community outreach, whether it could be providing care kids diagnosis for early diagnosis or talking about early vaccination. But that evolved into having a continuing engagement now talking about cancer screening, seasonal flu shot and other things. So that trust takes time and it needs to be intentional. Same thing addressing misinformation and disinformation. Then we can also collaborate with the community once we establish that collaboration and using their input to have a community informed journey map. For example, in cancer screening, when we talk about whether in that cancer screening journey, whether our potential way that we can incorporate digital solutions to address the digital divide, in this case, some work done by Dr. Gesser-Ortega, where we address language equity through the GENIE app, which is on-demand interpreter services that not only can be used within the healthcare world, but also outside when the patient is picking up their prescription or getting their grocery or trying to understand prep for their study, they can use them outside of the healthcare world. Because community led transformative care, it's important and it has to be part of the fabric of everything that we do. Not only a part of, but it has to be incorporated into every single aspect from developing your lung cancer screening program to the outreach, to the implementation and the consistent outcomes evaluation for them. For example, some of the work that we do, not only when we talk about community informed equity lung cancer screening, so we've done work through the screen assist clinical trial led by Dr. Park, Dr. Rigotti, and Dr. Haas, where they integrate tobacco cessation into lung cancer screening, part of the work as a co-investigator was to tailor the outreach for the recruitment point for the patient. So before the community engagement, it was a recruitment video only done by investigators. After the community engagement, we got some feedback. Now we had a patient that was part of the recruitment video. Even the patients told me that they wanted me to do the video without a tie because that make them more accessible. So those are the things that help us with how we connect with patients. And then not only is something about their preference, but also black African American participants were more likely to enroll in this study compared to non-Hispanic whites. A recent study that we did through Health Equity and Access for Lung Screening, or HEALS, when we have the typical IRB recruitment form that we share across, and then we gave it to a community-based organization, La Collaborativa, which is in Chelsea, that takes care of patients in high proportion of Latino and also immigrants. And they were partners with us in this study. And what they did is that they grabbed that form, and it didn't resonate with them. They put it with their color schema for their organization, and it made it into a way that it resonated with their community. Not only that allows us to engage with patients, but also build trust because they are trusted in their community. So something that I was touched before was about meeting patients where they are. And I think that that's an important component when we're looking to transform our lung cancer screening because that intentionality is needed. Not only we have to meet patients where they are, but we have to co-create, share vision and goals with them, let them lead your care, let them guide you in this process so you learn from them. And then you form true partnerships with them, with the community, and you become members and become part of the care team as well. And then you can advance equity in lung cancer screening together. So we can leverage the community engagement continuum to advance equity in lung cancer screening that starts with that outreach connection, then consulting the community, then that moves into involving the community in your care or your outreach or your research. Then you collaborate as partners, and then you have a shared leadership where you advance in lung screening together, equity in lung cancer screening together. So some of the take-home points here are to always keep in mind that patients and their communities are the center of everything that we do in lung cancer screening. Also the commitment, long-term commitment, that is non-transactional, it needed to go from a credible source to a trusted source in the community, because those two things are different and trust takes time. So you can see that later this week I'll be participating in a webinar with the ACS and the Consulate of Mexico in Boston talking about lung screening. I'll be at a health fair in La Colaborativa later on, community-crushing cancer part of the event next month, so that there's no research or anything behind it, just a continued commitment. And then now we're moving into touch, Shannon talked a little bit about minority stress and the next phase going from C codes to genomes and understanding how all these stressors and structural discrimination and barrier impact tumor genesis and more so epigenetic and physiologic mutation of tumors and worst outcome that we are seeing. Because the work that we're doing here not only impacts our patients now, but also our patients in the future. And our work is never done until no one is left behind. Thank you.

community engagement

lung cancer screening

social determinants

health equity

patient-centered care