Engaging Communities and Building Trust: Dr. Gieske Shares Insights From Rural Appalachian Lung Cancer Screening Initiative

Michael R. Gieske, MD, Director of Lung Cancer Screening at the St. Elizabeth Cancer Center, joined Lung Cancers Today at the IASLC 2024 World Conference on Lung Cancer to discuss his presentation on how understanding community perceptions and practices can help inform lung cancer screening interventions.

Dr. Gieske’s presentation focused on the Rural Appalachian Lung Cancer Screening Initiative, which has been recognized by the President’s Cancer Moonshot program and is led by the Association of Cancer Care Centers, the Appalachian Community Cancer Alliance, and patient advocacy partners.

“We were tasked with looking at this area and devising a project that could demonstrate that we increased lung cancer screenings, and we had some significant and substantial results through that process,” Dr. Gieske said.

The initiative aims to improve lung cancer screening rates by supporting health care systems in the rural Appalachian region in the development and implementation of interventions to overcome barriers to screening.

“We looked at geospatial mapping for the country and we looked at the area where it was the worst incidence of lung cancer, the worst mortality from lung cancer, and the poorest access in the country for health care for lung cancer,” Dr. Gieske said.

They found that the tri-state area of Kentucky, West Virginia, and Virginia specifically had significant barriers to screening and developed the initiative to support health systems in Pike County, Kentucky, and Buchanan County, Virginia.

“We’ve been helping them to refine their processes for looking at lung cancer screening and trying to develop some very good benchmarking,” Dr. Gieske said, explaining that the benchmarking process is important because this information provides a comparison point to evaluate the impact of the program.

However, beyond the baseline data, it was critical to be aware of social and cultural considerations surrounding screening.

“It’s been very challenging. It’s always challenging to implement lung cancer screening… but there were some unique challenges in Appalachia because of the access issues and some of the cultural issues there too,” Dr. Gieske said. “It’s a difficult area to go into as an outsider and gain trust, and that was one of our chief goals.”

He explained how the team navigated the process of gaining trust and collaborating to improve lung cancer screening rates in the region.

“You have to learn about the culture of the area. For example, in Appalachia, one of the things we found out was that there is a very high premium placed on family values, family input, and family influence,” Dr. Gieske said. “So, one of our approaches was to work with family members to gain that trust, and if you have a family member that is going to encourage you to get lung cancer screenings, they’ve learned about the value of it and it’s so much easier to get that individual in for a lung cancer screen.”

Beyond reaching the public, it’s important to realize that reaching primary care providers is “paramount” in terms of increasing screening rates, he explained.

“If you can find primary care providers that are willing to be a champion for lung cancer screening or that that are willing to carry the torch and talk with other primary care providers and create some enthusiasm, that carries a lot of weight,” Dr. Gieske said.

For example, Dr. Gieske and his team identified primary care providers in the region and met with them on “an individual, personal basis” to discuss lung cancer screening. It’s also important to help providers understand the impact of lung cancer screening by emphasizing the positive results and recognizing providers who detect cases of lung cancer.

“For example, if I have a provider in my health care system that finds a stage I lung cancer, I send them a staff message. I say ‘Strong work. You saved this person’s life,’” Dr. Gieske explained.

It’s also important to help providers be informed on the overall data and the progress with lung cancer screening and detection.

“The results that are continuing to improve year after year because… when you bring these patients back, year after year after year, you’re going to be much less likely to find a cancer in the late-stage, stage III or stage IV,” Dr. Gieske said. “You’re going to catch it early when you can make the greatest difference.”

It’s also critical to help providers and patients understand that “lung cancer is no longer the death sentence that we’ve been used to seeing it as” and address the stigma surrounding smoking as a cause of lung cancer.

“It’s a very addictive habit and there’s a lot of blame, shame that goes around that… it’s trying to work with that stigma, and trying to defeat that, and helping patients to get off the cigarettes,” he said.

Dr. Gieske concluded by reflecting on the progress with the initiative and his hopes for the future.

“It’s recognized by the President’s [Cancer] Moonshot initiative and also the President’s Cancer Panel… we’ve established a significant level of success at this point and the individuals that are funding our program are going to continue the funding, so we’re going to be looking at doing this for another two or three years in this area, but then also branching out and going into other areas as well,” he said.