The role of this observational study is to access the feasibility of providing lung cancer screening using a designated nurse navigator through lung cancer screening clinic. Eligible participants will be identified using medical records, eligibility will be confirmed through phone call, screening visits will be scheduled as in-person visit or telehealth visit. Computed tomography screening will be performed at an approved center closer to the individuals place of living and results will be discussed during follow-up in-person visit or telehealth visit.

The long-term goal is to establish healthcare practices to increase adherence to lung cancer screening among high-risk individuals. The overall objective in this application is to establish a lung cancer screening initiative to proactively identify and screen eligible patients for LDCT using a designated nurse practitioner (NP) along with telehealth. The central hypothesis is that use of a designated NP along with telehealth will increase lung cancer screening via LDCT among high-risk, racial/ethnic minority, and rural/sub-urban patients. The rationale for this proposal is use of a NP and telehealth will help overcome the barriers physicians face in identifying eligible patients for LDCT including collecting additional information to determine eligibility, discussing the pros and cons of LDCT, providing smoking cessation/abstinence counseling, making shared decisions, and documenting this information in the patients' charts.

In this prospective cohort study the nurse practitioner (NP) will proactively identify eligible individuals for LDCT using EMRs that are shared across the Department of Family and Community Medicine at SIU. These patients will be contacted and those agreeing to undergo screening will be given a referral to a nearby LDCT center. The NP will follow-up with the patients with the results of the LDCT and will refer them for further management to their primary care physician. If the results are negative for nodules then they will be followed up on a yearly basis until the participants are older than 80 years or have other life-threatening health issues.

Inclusion Criteria:

• All individuals 50-80 years of age
• 20 pack-year smoking history
• Currently smoke or have quit within the past 15 years:

Exclusion Criteria:

• Individuals 49 years and below or 81 years and above
• Has not smoked in 15 or more years
• Individuals who develop a health problem that makes them unwilling or unable to have surgery if lung cancer is detected.

The risk of lung cancer increases with age and smoking status and hence this age range is recommended for receiving lung cancer screening. As per USPSTF criteria our screening initiative will include individuals 50-80 years, subjects of all sex/gender and all race/ethnic groups. Screening eligible individuals included in our pilot study consisted of 54.4 % women, 75% of non-Hispanic whites, 24% non-Hispanic blacks and 1.2% belonged to 'other' race category. Non-Hispanic black individuals with smoking history have a higher risk of developing lung cancer than a non-Hispanic white. Very few Hispanic persons and women tend to accumulate fewer pack-years over a long period of time.

The goal of this project is to look a at telehealth vs in-person screening. Overall aggregates will be shared with the scientific community to assess if telehealth is a better option for screening.