Collaboration to improve lung cancer screening for Blacks led by UAH nursing graduate student

A Huntsville Hospital project to determine and overcome barriers to lung cancer screening participation experienced by African Americans is being led by a University of Alabama in Huntsville (UAH) graduate student who is pursuing her doctor of nursing practice (DNP) degree at UAH, a part of the University of Alabama System.

Originally from St. Louis, UAH alumnus Antonia D. Bates-Ford, who goes by Danielle Ford, (Bachelor of Science, Nursing, 2008) is a current DNP student and an oncology clinical education specialist at Huntsville Hospital. She has been chosen as the project’s nurse navigator. The project’s principal investigator is Ford’s advisor, Dr. Amy Beck, a UAH clinical assistant professor of nursing. Ford will use the research as part of her DNP project.

In collaboration with the UAH College of Nursing (CON), the Huntsville Hospital Foundation received a $50,000 seed grant from the Society to Improve Diagnosis in Medicine (SIDM), under a grant from the Gordon and Betty Moore Foundation. This grant extends a previous Huntsville Hospital Cancer Committee collaborative grant with the American Cancer Society to address barriers to lung cancer screening.

“This is the first time that UAH and Huntsville Hospital have worked together on a project like this, and I am honored that they have trusted me with being part of a body of work that has the potential to really effect change in an underserved community,” says Ford, who is an oncology certified nurse, the program chair on the Oncology Nurses of North Alabama board and is on Huntsville Hospital Cancer Committee.

“I hope this project leads to more projects where Huntsville Hospital and UAH collaborate,” she says. “I feel very fortunate that Karen Adams, director of the Huntsville Hospital Center for Lung Health, recommended me for the opportunity to lend my expertise.”

The investigation will involve patients at two local clinics that service predominately African American patients and will take place from January through September of 2023, culminating with the presentation of findings at the SIDM conference in October 2023.

The research will utilize a retrospective baseline of referrals from Huntsville Hospital lung center screening data to measure the number of physician referrals for screening of patients who meet United States Preventative Services Taskforce (USPSTF) recommendations.

Also using the screening data, investigators will measure the number of African American patients screened and diagnosed for lung cancer, proportionate to the total number of patients screened and diagnosed. Provider education materials will be distributed and provider and nurse navigator educational conversations will be documented and tracked.

“My hope is that we will identify trends that can be easily evaluated and mitigated,” says Ford, who also is a graduate teacher in the CON Simulation Lab.

“I also hope that the result of this project shows how having a nurse navigator can be instrumental in bridging the gap in health inequities. Maybe the role will become a permanent fixture in the community.”

During the project, Ford will be responsible for educating healthcare providers on lung cancer screening guidelines and bringing awareness to prompt screenings.

“Once a patient is identified as needing a screening, I will be responsible for following up with the patient, encouraging and assisting them to get the screening complete,” she says.

“If any barriers to making the appointment are identified, I will have resources to help eliminate the barrier – such as gas cards, meal vouchers, various transportation vouchers, etc. I can also be available to help connect the patient to social workers, or any of the many resources that our center for lung health has to offer.”

All patients who are candidates for lung cancer screening face roadblocks to being screened, Ford says, adding that according to the American Lung Association, lung cancer carries a stigma because most people perceive it as a self-inflicted disease caused by smoking, even though not all lung cancers come from smoking.

“Lung cancer is a leading cause of death for males and females, but awareness is at an all-time low,” Ford says. “Due to the stigma, lung cancer does not have public empathy or a celebrity representative to take up the mantle like we see with breast cancer or pediatric cancers, for example.”

For African Americans, Ford says she believes that a combination of societal and structural issues contributes to screening roadblocks.

“Lung cancer incidence rate is about 32% higher in African Americans compared with European Americans, with disparities most predominant among men,” she says. “A lot of African Americans lack access to quality health care, have a lack of knowledge and have medical mistrust.”

African Americans are diagnosed with lung cancer at a younger age and do a poor job at following up with providers, Ford says.

“Providers are swamped with case-loads and don’t have the manpower to follow up with patients. It’s a cycle of not following up on both ends,” she says.

“If we think about being Black in the South, we have not always been treated with veracity in the medical community,” she says. “We think about our dark past, including the Tuskegee experiments and the case of Henrietta Lacks, for example. One can certainly understand the reluctancy.”

Some other roadblocks involve basic choices, Ford says. Patients sometimes must make decisions between paying for a ride to make a follow-up appointment or to go buy food, for example.

“We hope to eliminate the need for patients to have to make those tough decisions,” she says. “Last year I set up an information booth at a church health fair, and there were many people who were not aware of the many resources available or what the lung cancer screening involved.”

According to the American Lung Association, 30% of people don’t know much about lung cancer.

“African Americans, have previously experienced disproportionate underscreening because they are less often eligible for lung cancer screening, despite developing lung cancer at younger ages and with lower smoking intensity,” Ford says. “Studies show that this is in part due to the screening guidelines.”

Prior to 2021, the USPSTF recommended annual screening for lung cancer with low-dose computed tomography in adults aged 55–80 years who have a 30 pack-year smoking history, and currently smoke or have quit within the past 15 years. A pack-year is calculated by multiplying the number of packs of cigarettes smoked per day by the number of years the person has smoked.

The USPSTF broadened lung cancer screening eligibility in March 2021, lowering the minimum age to 50 years and decreasing smoking intensity to 20 pack-years.

“Since African Americans are diagnosed at a younger age, and have a shorter pack-year history, the hope is that the expanded criteria will increase the number of individuals with high risk who are eligible for lung cancer screening with low-dose computed tomography and further reduce lung cancer mortality,” Ford says.

The new research continues a COVID-forestalled research collaboration between Huntsville Hospital’s cancer committee and the American Cancer Society to address racial inequalities related to lung cancer in the African American community that was funded by the Community Foundation of Greater Huntsville.

“Due to COVID-19 we were not able to fully roll out a plan. The cancer committee worked on what it could, but we didn’t get to work within the community like we wanted to,” Ford says.

“This initial project is a big reason why I went back to graduate school,” she says. “I wanted to do something for lung cancer patients in my community that would effect real change, but I needed more education to help me with that.”

Speaking of getting more education, aren’t these a lot of hats for Ford to wear all at once? She credits her religious faith and the support of her husband, UAH alumnus Darvin Ford (Bachelor of Science, Accounting, 2014) and her four children.

“My faith keeps me grounded and helps me see things in a positive light, and I have an amazing husband and a village of support,” she says.

“A call or text from my big sister in St. Louis is always wonderful. Also, my best friends, who I lovingly call my sister friends, are part of my village that keep me on track. My two youngest children are school-aged, so my sisters help my husband with the carpool and after-school activities when I am tied up with class and work.”

Synchronizing their calendars helps she and her husband stay organized.

She says her Huntsville Hospital supervisor Brian Buchman, unit nurse manager Ruth Smith and the other medical service line educators have all been understanding and supportive of her graduate school journey.

“I am also grateful to Huntsville Hospital for being a great employer and investing in my future,” Ford says. “My ultimate goal once I finish my DNP is to teach in the CON. The UAH CON is affording me a real-life opportunity to reach that goal and effect change in my community.”

UAH’s online classes are flexible and make going to school possible, Ford says, but it’s those who encourage and help along that way who make the difference.

“I believe that if a person does not have a firm support system it will be challenging to successfully attend graduate school, work full-time, graduate teach and have a personal life,” she says.

“Graduate school has been plenty of late nights and early mornings, but my children, husband and sisters are so encouraging and motivating. Their support, along with my faith, are what keeps me going.”

---