Examining implementation strategies to reduce disparities in lung cancer screening uptake by state Medicaid expansion status: a scoping review.

Background: Lung cancer screening (LCS) has reduced lung cancer mortality by 20%, yet uptake in the U.S. remains low, especially among underserved populations. We evaluated implementation strategies designed to reduce disparities in LCS uptake based on race, ethnicity, income, and rurality and examined trends by state Medicaid expansion status. Methods: We conducted searches in MEDLINE via PubMed, Web of Science, and Embase. We screened primary studies and extracted data with assistance from four reviewers in Covidence in line with Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Studies were assessed for study design, intervention type, target population, etc. and stratified by state Medicaid expansion status. Results: Our review included 37 studies encompassing patient navigation, community outreach, and decision aids. Patient navigation was prevalent in both groups of states, whereas community-based approaches were more common in Medicaid non-expansion states. Most interventions showed some improvement in uptake of LCS, though the degree of impact varied across studies. Conclusion: This review demonstrates the nuanced landscape of effectiveness and challenges with addressing LCS disparities. A wide range of strategies showed some effectiveness and barriers to uptake varied depending on context, underlining the need for tailored strategies.