TOPLINE

In a randomized trial, reminders sent to both primary care doctors and patients increased lung cancer screening rates by about 28 percentage points, achieving more than 75% adherence.

METHODOLOGY

• Over 14 million Americans are currently eligible for annual lung cancer screening with low-dose CT, but adherence hovers been 22% and 50%. Multilevel interventions to address screening barriers have yet to be tested in clinical trials.
• Researchers at Kaiser Permanente Washington conducted a pragmatic trial of two multilevel interventions aimed at lung cancer screening adherence. They enrolled 1837 patients who had an index scan with normal findings and randomized them to one of four arms: usual care, health communication only, “stepped reminders” only, or both interventions.
• The stepped reminders intervention alerted primary care physicians to order a patient’s annual low-dose CT about 4 weeks prior to the due date; patients then received messages via patient portal and mail to schedule the screening. Patients in the health communication intervention received a message 3 weeks after their index scan, via portal video and/or mail; it reminded them their next scan was due in 12 months and offered general encouragement.
• The primary outcome was completion of lung cancer screening or diagnostic chest CT within 9-15 months of the index scan, adjusted for age, sex, tobacco status, and lung cancer screening history.

TAKEAWAY

• Overall, screening adherence was 75.5% with the stepped reminder intervention vs 47.4% with no reminders (relative risk [RR], 1.59; P < .001). In contrast, screening adherence was lower among patients who received the health communication intervention relative to those who did not (59.2% vs 63.3%; RR, 0.93; P = .04).
• Nearly half of the trial patients (47.6%) were current smokers, and the stepped reminders were particularly effective for them: The intervention improved their screening rate to a greater extent (73% vs 41.2% with no reminders; risk difference, 32.3 percentage points) compared with former smokers (77.8% vs 52.9%; risk difference, 24.1 percentage points; P for interaction = .03).
• The health communication intervention showed a differential effect by sex, with female participants having lower screening adherence than those who received no health communication (54.4% vs 63.4%; RR, 0.85). The intervention showed no impact on screening rates among male participants (63.5% vs 63.3%; RR, 1.00; P for interaction = .04).

IN PRACTICE

“ Integrating intentional, multilevel reminders into [lung cancer screening] workflows may be essential for achieving the population-level mortality benefit of screening,” the study authors wrote. The lack of benefit from the health communication intervention, they added, “underscores the importance of timing of patient education and behavioral context.”

SOURCE

This study, led by Karen J. Wernli, PhD, of Kaiser Permanente Washington Health Research Institute in Seattle, was published online in JAMA Internal Medicine.

LIMITATIONS

The trial population was predominantly White and insured, which may limit generalizability. The cost of the interventions, which could be a barrier in resource-constrained healthcare systems, was not evaluated. Participant-level data on engagement with the health communication intervention were lacking.

DISCLOSURES

This study was supported by the National Cancer Institute. Wernli disclosed receiving grants from Lilly outside the submitted work. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.