A100-05 Effectiveness of Patient and Clinician Strategies on Increasing Adherence to Annual Lung Cancer Screening and Diagnostic Surveillance: A Pragmatic Factorial Trial

Abstract Rationale Timely completion of annual low-dose CT (LDCT) and diagnostic surveillance is essential to ensure that the potential benefits of lung cancer screening (LCS) are achieved in practice. However, LCS adherence remains remarkably low and inequitable in the US, highlighting the critical need for designing and implementing effective strategies to increase adherence across populations. Methods Using a pragmatic, factorial (2x2) trial design (NCT05832008), we tested the effectiveness of using patient and clinician nudge strategies (alone and or in combination) to increase adherence among adults overdue for annual LCS or diagnostic surveillance (based on prior LDCT results). Eligible primary care clinicians or pulmonologists with at least one patient overdue for screening were randomized (1:1 stratified by quartile baseline LCS rates) to receive either the Clinician Nudge (CN), an EHR-based pended order for CT scan or direct alert if an active order existed, or no CN. Eligible patients were randomized (1:1 stratified by enrolled clinician) to receive the Patient Nudge (PN), a gain-framed reminder delivered via text message, or no PN. The primary outcome was adherence, defined as completion of recommended LDCT or CT scan within 90 days, compared at the patient level and across the four study arms. We used multivariable logistic regression (aOR; 95%CI). to assess the effectiveness of each strategy in comparison to usual care, and to each other, adjusting for covariates associated with LCS adherence. The study is supported by the National Comprehensive Cancer Network (NCCN) through a grant provided by AstraZeneca. Results A total of 225 clinicians and 600 patients were randomized to one of the four arms. Fifteen patients (2.5%) were excluded after randomization due to trial ineligibility, resulting in a total analytic sample of 585 patients (Table 1). In comparison to UC (8% adherence), each strategy significantly increased adherence, ranging from 18% for PN alone (aOR=2.5; 95%CI: 1.2-5.2), 24% for CN alone (aOR=3.8; 95%CI: 1.9-7.8), and 31% for both PN+CN (aOR=5.0; 95%CI: 2.5-10.0). Adherence in the PN+CN arm was significantly higher than PN alone (aOR=2.0; 95%CI: 1.1-3.5) but not CN alone (aOR=1.3; 95%CI: 0.7-2.2). No significant differences were observed between PN versus CN alone. Conclusions Our pragmatic trial highlights the effectiveness of using low-touch strategies to increase adherence among patients overdue for LCS. While patient nudges significantly increased adherence in comparison to usual care, they did not increase adherence over clinician strategies alone, highlighting potential options for implementing strategies depending upon available resources. This abstract is funded by: This study is supported by NCCN through a grant provided by AstraZeneca.