Optimising lung cancer screening for Maori: A study of comparative invitation processes

The study is focused on Maori participants who are at high risk of lung cancer. Groups will be cluster randomized (at general practice level) 1:1 between central hub and primary care hub invitation approaches, and the aim is to scan 550 participants in total. Lung cancer is a common cancer and cause of death for both Maori and non-Maori in New Zealand, but is especially prevalent in Maori. Earlier detection of asymptomatic lung cancer through lung cancer screening using low-dose CT scans has been proven to shift the stage of diagnosis of lung cancer, and to reduce mortality. There is currently no national programme for lung cancer screening in New Zealand, and before any progamme can be introduced there are key implementation questions that need to be addressed. In addition, any programme must ensure that Maori participation is at least equal to non-Maori participation to ensure that the already significant equity gap is not increased by such a programme. In this community cluster Randomised Controlled Trial, two lung cancer screening invitation pathways will be tested end to end, including invitation methods, risk assessment, shared decision making and CT scan. The key intervention being tested between the two groups is whether recruitment rates are better with a GP led invitation process. Participants in the GP led (intervention) arm of the study will be invited to participate via their GP practice. The invitation will be sent initially via a letter and information booklet, with follow up phone calls / emails to ascertain willingness to participate. Key study processes are listed below. The risk assessment and shared decision making will be facilitated by the primary care nurse, either face to face or over the phone; Risk assessment, conducted in a face to face visit or phone call and expected to take around 20 minutes. Only those participants identified as at high risk of developing cancer will be invited for a CT scan. Shared decision making, conducted in a face to face visit or phone call and expected to take around 30 minutes. This can be done immediately after the risk assessment, or at a separate appointment. In the shared decision making process, all participants identified as being at high enough risk to undergo CT scan will be taken through the potential risks and benefits of having a CT scan for lung cancer screening. CT scan. If a participant consents, a separate appointment will be made for a CT scan at a community radiology facility. The scan appointment will take around 30 minutes and will be conducted by a qualified radiologist. Follow up will be personalised according to the results of the CT scan, where any findings, including incidental findings, will be followed up accordingly.