{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T10:38:48Z","timestamp":1792579128841,"version":"4.5.0"},"reference-count":35,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["U54CA118948"],"award-info":[{"award-number":["U54CA118948"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Cancer Control"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Lung cancer is the leading cause of cancer-related death in Alabama, where screening uptake remains well below national benchmarks. Decentralized screening programs, in which referring providers manage eligibility identification, referrals, and follow-up without dedicated coordination infrastructure, are common across clinical settings. Yet the relationship between program design and delivery outcomes in decentralized contexts has received little attention. This study examined how a decentralized lung cancer screening program delivered screening across each step of the pathway, from patient identification through annual follow-up. The goal was to identify where and how program design produced gaps in delivery from the perspectives of patients and providers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This qualitative study used semi-structured interviews conducted between July 2023 and May 2024 at an academic medical center in Alabama as part of a larger explanatory sequential mixed methods study. Fifteen patients who had completed screening and six providers representing primary care, pulmonology, and radiology participated. Interviews explored screening awareness, decision-making, and program delivery processes. Transcripts were analyzed using the Consolidated Framework for Implementation Research (CFIR) and constant comparative method. Reporting followed the COREQ guideline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Delivery failures were structural and concentrated at the front end of the screening pathway. Eligibility identification depended on incidental patient exposure rather than systematic outreach. Referrals reflected individual provider initiative rather than standardized workflows. Result tracking and nodule follow-up fell to ordering providers without dedicated support. Coverage gaps and geographic distance compounded these determinants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Reduced uptake in this decentralized program pointed largely to structural barriers. Closing the implementation gap may require program design changes and proactive outreach that does not depend on the clinical encounter to begin.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10732748261500335","type":"journal-article","created":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T14:02:51Z","timestamp":1792332171000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Lung Cancer Screening Delivery in a Decentralized Program: Patient and Provider Perspectives"],"prefix":"10.1177","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9296-7726","authenticated-orcid":false,"given":"Ashleigh M.","family":"Allgood","sequence":"first","affiliation":[{"name":"University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Edward","family":"Murrell","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arya A.","family":"Tamhane","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shantay","family":"Williams","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regan","family":"Gaskin","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7358-6044","authenticated-orcid":false,"given":"J\u2019Aime C.","family":"Jennings","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desiree","family":"Rivers","sequence":"additional","affiliation":[{"name":"Department of Community Health and Preventive Medicine, Morehouse School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sejong","family":"Bae","sequence":"additional","affiliation":[{"name":"Augusta University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark T.","family":"Dransfield","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soumya J.","family":"Niranjan","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,18]]},"reference":[{"key":"e_1_3_8_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djaa170"},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1102873"},{"key":"e_1_3_8_4_2","doi-asserted-by":"publisher","DOI":"10.7326\/M13-2771"},{"key":"e_1_3_8_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.1117"},{"key":"e_1_3_8_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10552-024-01929-6"},{"key":"e_1_3_8_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmw146"},{"key":"e_1_3_8_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/hex.12433"},{"key":"e_1_3_8_9_2","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201703-204PS"},{"key":"e_1_3_8_10_2","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202206-495ED"},{"key":"e_1_3_8_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2021.09.002"},{"key":"e_1_3_8_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-022-01245-0"},{"key":"e_1_3_8_13_2","volume-title":"Designing and Conducting Mixed Methods Research","author":"Creswell JW","year":"2017","unstructured":"Creswell JW, Plano Clark VL. Designing and Conducting Mixed Methods Research. 3rd ed. Sage; 2017.","edition":"3"},{"key":"e_1_3_8_14_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0232076"},{"key":"e_1_3_8_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/15586898241257546"},{"key":"e_1_3_8_16_2","doi-asserted-by":"publisher","DOI":"10.46743\/2160-3715\/2013.1569"},{"key":"e_1_3_8_17_2","doi-asserted-by":"publisher","DOI":"10.3233\/EFI-2004-22201"},{"key":"e_1_3_8_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"e_1_3_8_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2024.108143"},{"key":"e_1_3_8_20_2","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.70054"},{"key":"e_1_3_8_21_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2024.1662"},{"key":"e_1_3_8_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2016.10.027"},{"key":"e_1_3_8_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-019-05516-3"},{"key":"e_1_3_8_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2021.01.041"},{"key":"e_1_3_8_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2025.109303"},{"key":"e_1_3_8_26_2","doi-asserted-by":"publisher","DOI":"10.21037\/ccts-24-31"},{"key":"e_1_3_8_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2025.04.033"},{"key":"e_1_3_8_28_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.8559"},{"key":"e_1_3_8_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2023.05.016"},{"key":"e_1_3_8_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cllc.2024.08.002"},{"key":"e_1_3_8_31_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.15383"},{"key":"e_1_3_8_32_2","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2023.7094"},{"key":"e_1_3_8_33_2","unstructured":"American Lung Association. New Report Reveals Alabama Among Worst in Nation for Lung Cancer Survival Rate. 2024. https:\/\/www.lung.org\/media\/press-releases\/solc-alabama-2024#:\u223c:text=Alabama_is_the_only_state coverage_gap_through_Medicaid_Expansion (Accessed 17 March 2026)."},{"key":"e_1_3_8_34_2","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-24-0725"},{"key":"e_1_3_8_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.lungcan.2025.108615"},{"key":"e_1_3_8_36_2","doi-asserted-by":"publisher","DOI":"10.1177\/10732748241258589"}],"container-title":["Cancer Control"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10732748261500335","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10732748261500335","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10732748261500335","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T09:46:37Z","timestamp":1792575997000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10732748261500335"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":35,"alternative-id":["10.1177\/10732748261500335"],"URL":"https:\/\/doi.org\/10.1177\/10732748261500335","relation":{},"ISSN":["1073-2748","1526-2359"],"issn-type":[{"value":"1073-2748","type":"print"},{"value":"1526-2359","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"article-number":"10732748261500335"}}