Lung screening in Canada, 2023-24

Specific communities, partners, and organizations

British Columbia

Focus testing was employed with a diverse group of individuals to ensure program materials were impactful and understandable amongst equity-seeking populations and communities. First Nations Health Authority participated in the program’s Patient Pathway Working Group.

Alberta

The Alberta Lung Cancer Screening Program (ALCSP) met with Alberta Health Services (AHS) Indigenous Wellness Core leaders and staff (including cancer navigators), Wisdom Council, Métis Nation of Alberta, and First Nations Information Governance Centre. A member of the AHS Indigenous Wellness Core sits on the steering committee and another member sits on the Communications and Engagement Working Group.

In partnership with the AHS Indigenous Wellness Core, the program developed an Indigenous Engagement Plan.

The program also shared information with Friendship Centres in the targeted geographic areas.

Saskatchewan

Partners include Ministry of Health, the Saskatchewan Health Authority, Northern Inter-Tribal Health Authority, and Métis Nation Saskatchewan. These key stakeholders have worked together to assess provincial readiness and develop a governance framework and project plans to support program development.

The Community Working Group includes representation from 32 of 33 northern First Nations which comprise the Northern Inter-Tribal Health Authority. It also includes a variety of members from communities, including community health representatives, an elder, health promotion and public health staff, nurses, tobacco cessation practitioners, and representation from Métis Nation Saskatchewan.

This group represents community perspectives on program design and operations. Not only do they provide their own community and partner organization perspectives, but they have also developed a community engagement. They are also making recommendations and providing input on all aspects of the program development.

Manitoba

Public awareness and education material has been reviewed in focus groups, surveys, and with First Nations Community Health Representatives. Additional work is underway to ensure that people without a PCP can refer to and access lung cancer screening.

Ontario

Ontario works with First Nations, Inuit, Métis and urban Indigenous communities.

Quebec

Quebec works with Indigenous peoples in Côte-Nord.

New Brunswick

NBCN anticipates working with the following groups (as is done with colon, breast, and cervical screening programs):

• Federally insured individuals (correctional facilities)
• First Nations community health clinics
• Women’s Equality Branch/gender-diverse people

Nova Scotia

Based on the IAP2 Engagement Spectrum, NS collaborated with:

• Mi’kmaq First Nations
• Nova Scotians of African descent
• 2SLGBTQIA+

Based on the IAP2 Engagement Spectrum, NS informed/consulted with:

• New immigrants
• Lower socioeconomic urban populations

Highlights in population outreach and engagement

British Columbia

Ongoing engagement with PCPs regarding referral pathways and appropriateness of referrals to ensure the eligible population is aware of the program and processes to access screening.

Saskatchewan

Together, the Community Working Group and the Clinical Working Group have made key decisions to inform work, such as the program eligibility policy.

New Brunswick

New Brunswick Cancer Network has an existing communication, awareness, and marketing plan for our population-based cancer screening programs (colon, breast, and cervical). Strategies include: radio advertisement, Government New Brunswick (GNB) Facebook, GNB Twitter, paid Facebook and Instagram ads, digital programmatic ads on popular New Brunswick websites (Kijiji, CBC, Yahoo, and The Weather Network), digital screens in Regional Health Authorities and Service New Brunswick centres, digital billboards in major cities (Moncton, Saint John, and Fredericton), public transit ads (Moncton, Saint John, and Fredericton areas), digital news platforms (Telegraph Journal and Acadie Novelle), and Google search promotional ads.

Nova Scotia
The lung screening program has the full support of our medical and executive leadership to achieve the required outcomes with equity-deserving groups. We are committed to meeting the needs of our highest-risk groups, thereby ensuring we meet the needs of all Nova Scotians.

Strategies used to identify and reduce barriers to screening participation

British Columbia

A geospatial mapping approach was used to map the locations of the 36 screening sites in BC. Utilizing lung cancer cases in health units across BC as a proxy for the screen-eligible population, the impact of urbanization and individual components of Statistics Canada’s Canadian Index of Multiple Deprivation (composed of sociodemographic and economic indicators) were considered, in addition to vehicle travel time. This data serves as the basis for determining if screening uptake is proportional to the locations of lung cancer cases.

Alberta

The Alberta Lung Cancer Screening Program (ALCSP) chose primary care networks (PCNs) in the province with higher smoking rates, including a PCN in Northeast Calgary with higher immigrant and Indigenous populations. The O-day’min PCN in Edmonton also has a higher Indigenous population. The program also chose a site in the North Zone, upon recommendation from the Indigenous Wellness Core and Wisdom Council. This PCN also has a high Indigenous population.

The ALCSP accepts referrals from the two Alberta Health Services (AHS) Indigenous primary care clinics at Sheldon M. Chumir Health Centre in Calgary and at the Royal Alexandra Hospital in Edmonton.

The ALCSP accepts referrals from The Alex Centre in Calgary, serving a community facing complex health challenges, including poverty, trauma, financial and housing instability, food insecurity, and a need for social and community inclusion.

A number of primary care clinics participating in the program serve recent immigrants and refugees, including the Mosaic Refugee Clinic.

The Edmonton Southside Clinic sends referrals from the COPD/Asthma Clinic.

Several referrals have used the AHS language line for translation services, with the top five requested languages being Hindi, Vietnamese, Arabic, Mandarin, and Cantonese. The program translated the program poster and patient brochure into Vietnamese and simplified Chinese, which were made available at several clinics and on their website.

The ALCSP has presented to many community groups, including members of the Philippines Consulate.

Saskatchewan

A key success early in program development was the creation of a project governance and shared decision-making structure to support full collaboration between the provincial health system and community partners, particularly northern and other high-risk populations. Northern Saskatchewan is composed of rural communities, approximately 87.4% of which are First Nations and Métis. Northern residents are at higher risk of being diagnosed with later-stage lung cancer. Smoking rates in this population are twice that of the rest of the province. Additionally, lung cancer survival rates are poorer. These communities are also located geographically far from CT scanners, where lung screening takes place.

Manitoba

Equity-deserving groups are identified through data, public and community consultation (focus groups, surveys, public advisory), and consultation with healthcare providers, including First Nations Community Health Representatives.

Ontario

Engagement with Regional Cancer Programs and work with Regional Primary Care Leads has been important in identifying equity-deserving populations within each region and tailoring recruitment strategies to ensure they are appropriate and effective.

Quebec

Videos produced for Indigenous populations in Côte-Nord.

The pilot project’s initiatives and efforts will continue in phase two, thanks to CPAC funding to hire a dedicated coordinator.

New Brunswick

Based on feedback received through our provincial cancer screening line, GIS mapping, etc., and on experience with our other cancer screening programs, New Brunswick anticipates identifying equity-deserving populations or communities with barriers to screening. These include:

• Low-income
• Recent immigrants and refugees
• Non-English and non-French speakers
• People without a PCP
• People with comorbidities or chronic illness
• People with mental illness
• People with physical disabilities
• People who are houseless
• Specific geographic areas
• Federally insured individuals (correctional, armed forces, RCMP, refugees, immigrants)
• Gender-diverse people

Nova Scotia

Literature scan explored potential differences in behavioural barriers experienced by the identified groups of marginalized communities.

The scan identified behaviourally informed interventions. Nova Scotia undertook qualitative research with the intention to investigate potential behavioural barriers to awareness and uptake of cancer screening. Consultations happened with seven pre-identified, historically marginalized populations/communities.

Received consistent messaging from all seven community consultations:

• An adequate communications and engagement approach will require co-designed community engagement that includes trusted community members
• If trusted members of the community are not engaged, community members are likely to hesitate to participate in the program. This is especially true for groups that mistrust the healthcare system because of stigma and historical factors

A more diverse engagement approach means more trust in the Cancer Care Program and outcomes, resulting in more trust and interest in participating in the lung screening program.

Prince Edward Island

Engagement with First Nations, immigrant, and refugee populations is being completed with various cancer screening programs. Findings will be applied to lung screening planning.

Newfoundland and Labrador

Pilot program has not been initiated yet, but currently have a Recruitment and Eligibility Working Group to advise on the program.