Lung screening in Canada, 2023-24

• Delivering multiple presentations to different stakeholder groups, including time for questions and discussion.
• Holding key stakeholder interviews.
• Forming community advisory/working group(s).
• Building relationships with community champions.
• Targeted education/awareness campaigns (e.g., social media).

• Overarching provincial strategy used by all sites with tailored regional/local outreach for equity-deserving populations. Local outreach includes both primary care provider and public/community led strategies. Local community strategies for engaging equity-deserving populations vary across sites.
• Focus groups and interviews were conducted between 2013 and 2015 to help inform the development of the Ontario Lung Cancer Screening Pilot for People at High Risk. Participants were current and former heavy smokers who were diverse with respect to age, gender, income and educational attainment.

• Educational and awareness campaigns (e.g., social media)
• Videos
• Building ties with community leaders

• NBCN anticipates continuing existing approach, as is done with colon, breast, and cervical screening programs.
• Federally insured individuals (correctional facilities):  building relationships with community champions, and facilitating inmate screening participation with health care providers (completion of questionnaires and health assessments).
• First Nations community health clinics/events: building relationships with community champions, and targeted education (presentation or information booth upon invitation).
• Gender-diverse population: program staff completing online training, and updating the content of program materials to better reflect gender inclusivity.

• Remain in contact via e-mail with groups and inform through scheduling presentations.
• Consult with Community Health, Mental Health and Addictions, North End Community Health Centre, First Nations communities, patient and family advisors, Immigrant Services Association of Nova Scotia, and Health Association of African Canadians.
• Collaborate with Mi’kmaq First Nations, Nova Scotians of African descent, and new immigrants.
• In addition to consultations with these communities, we are planning to have community liaison staff positions representative of the Mi’kmaq First Nations, Nova Scotians of African descent, and new immigrants.

For those with fear of cancer due to lack of knowledge, misconceptions, or negative attitudes toward testing, Alberta has:

• Developed and shared patient brochure to help inform and address fears
• Provided FAQs and PCP resources (also available on their website)
• Delivered education sessions to PCPs and allied health staff to help increase awareness and knowledge of the program; they can share this with their patients
• Provided a toll-free phone number and program email for patients and providers to call with questions and concerns about the program/screening

For those with scheduling conflicts or lack of time to get tested, Alberta is allowing patients to reschedule. Appointment notification letter provides phone number to reschedule appointment if needed.

For those with low health literacy, plain language specialist has reviewed our patient resources and website content for health literacy.

To address lack of culturally appropriate health promotion materials, Indigenous Wellness Core, primary care networks (PCN) reps, and patient and family advisors have reviewed resources to ensure they are culturally appropriate.

To address those with previous experiences of racism and/or discrimination who lack trust in the health system, all AHS staff are now required by policy to complete Indigenous learning.

The two required learnings are part of the Required Organizational Learning (ROL) program and all staff must complete each course once:

• Required Organizational Learning (ROL) – Indigenous People in Alberta Introduction
• Required Organizational Learning (ROL) – Indigenous Awareness & Sensitivity Certification Program (complete as seven eLearning modules or attend a three and a half-hour workshop)

Additional training is available and recommended for staff to complete. PCPs are also recommended to complete the training.

Ontario Lung Screening Program (OLSP) sites are responsible for local recruitment and have developed various strategies to engage equity-deserving populations within their regions.

At a provincial level, Ontario Health continues to support engagement of equity-deserving populations:

• All sites are able to implement a hub-and-spoke model to improve access to screening, where participants are screened closer to home at the spoke sites.
• OLSP sites accept self-referrals and will help attach individuals to a primary care provider for the purposes of lung cancer screening.
• Program resources are being updated to include gender-neutral and inclusive language.

• Self referrals for unattached patients
• GAP referral process for follow up on incidental findings
• Collective prescription for coordination centre nurses to initiate screening process
• Social media

• For those without a regular health care provider, individuals can participate in the program without a PCP referral.
• For those with language barriers, the program has on-the-phone interpreter services available. Staff is fluent in French and English.
• For those without a screening recommendation from health care provider, the lung program will have clinical practice guidelines and will regularly communicate with health providers about program updates to activities and recommendations.
• For those with difficulty accessing the health system, NB Cancer Screening Line receives and handles calls from individuals with inquiries regarding access to screening services.
• For those with low health literacy, print instructions and information sheet will be developed with images and simplified language.
• Recent immigrants and refugees with federally issued health cards will be invited to participate in program.
• To address barriers for gender-diverse people, program staff completing online training and updating screening program content. Program materials and guidelines will be developed to reflect gender inclusivity.