BPI22-010: Applying FRAME to Code Modifications to a Community-Based Educational Intervention and Lung Cancer Screening Protocols Amidst the Covid-19 Pandemic

Background: While lung cancer is a leading cause of death in the U.S., annual screening rates with low-dose Computed Tomography (LDCT) among eligible candidates remain low at 12.7%. The WUSTL research group began a community intervention to increase LDCT screening called I-STEP (Increasing Screening Through Engaging Primary Care Providers) from 2019-2021 to address this quality gap. An educational Toolkit was administered to a consortium of six hospital systems in Missouri and Illinois, covering screening eligibility and follow-up guidelines, navigating screening referral, and smoking cessation. Screening increased 18% following implementation of I-STEP. The COVID-19 pandemic prompted unforeseen changes to the healthcare landscape, wherein modifications to care delivery and I-STEP became crucial to optimize outcomes. Methods: We used the expanded framework for reporting adaptations and modifications to evidence-based interventions (FRAME) to code changes to I-STEP and screening protocols during the pandemic. Data was collected via reports and phone calls with stakeholders within the consortium. Changes were analyzed by stage, if they were planned, decision-makers behind changes, what was changed and who was affected, nature of the modification, fidelity to standard of care, and reasoning for modification. We hypothesize that FRAME will contribute to an evidence base for refining I-STEP and care delivery to meet the demands of a dynamic clinical environment. Results: Hospital administrators and clinic staff prompted modifications to screening services and I-STEP implementation across sites. Targets of changes ranged from patients and clinicians, to more broadly at the healthcare system and hospital network levels. Fluctuating clinic staff due to furloughs and redeployment to high-acuity services prompted changing staff training models and clinic workflow, including training staff to consult with patients on LDCT results, streamlining LDCT scheduling protocols given limitations on elective imaging, and using electronic health record and mail-based alerts to engage patients lost to follow up. I-STEP modifications included engaging more staff in implementation and translating the Toolkit from paper to digital format to accommodate remote access. Changes were fidelity consistent. Conclusion: FRAME identified commonalities in process, nature, and justification for modifications to contextualize screening and implementation outcomes amidst COVID-19.