Date of Conferral

1-29-2026

Date of Award

January 2026

Degree

Doctor of Healthcare Administration (D.H.A.)

School

Management

Advisor

Laurie Latvis

Abstract

Lung cancer is the leading cause of cancer-related mortality in the United States, with underserved populations experiencing higher rates of late-stage diagnosis and preventable death. Despite established screening guidelines, adherence within primary care remains inconsistent, particularly in safety-net settings, reflecting a healthcare administration problem driven by organizational structures and care processes. The purpose of this integrative review was to identify administrative interventions that improve primary care provider adherence to lung cancer screening referral guidelines in safety-net healthcare settings. Guided by the Donabedian Quality Framework, a systematic integrative review was conducted to examine how healthcare structures and processes influence screening implementation. Study quality and relevance were appraised using the Johns Hopkins Nursing Evidence-Based Practice appraisal tools. The synthesis yielded five themes and fifteen subthemes representing evidence-based administrative strategies, including improving provider knowledge and education, strengthening health system infrastructure, reducing workforce and administrative barriers, advancing equity and positive social change, and enhancing patient access and engagement. Key subthemes included guideline-based provider education, shared decision-making support, standardized referral and follow-up workflows, electronic health record–enabled eligibility identification, defined care team roles, and reduction of access barriers related to insurance, transportation, and cost. These findings directly address the review question by demonstrating that coordinated administrative interventions are essential to improving guideline adherence, expanding screening access, and reducing lung cancer disparities in underserved primary care populations.

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