Physician-led telephonic outreach significantly increased low-dose CT lung cancer screening completion compared to historical nurse-led email outreach (22.3% vs 5.1%; p<0.0001).
Cohort (n=858)
No
Does physician-led telephonic outreach improve lung cancer screening LDCT completion rates compared to nurse-led email outreach in high-risk urban patients?
Physician-led telephonic outreach significantly improves lung cancer screening completion rates among high-risk urban patients compared to nurse-led email outreach.
Absolute Event Rate: 22.3% vs 5.1%
p-value: p=<0.0001
Abstract Introduction Lung cancer remains the leading cause of cancer-related deaths in the United States. Smoking history imparts a significantly higher risk of developing lung cancer, accounting for 80% of all lung cancer cases. Despite current recommendations of screening with low-dose computed tomography (LDCT), completion of screening remains disappointingly low, especially among the socioeconomically disadvantaged. This gap highlights the need for innovative outreach strategies to improve screening rates among high-risk populations. Our study compares the effectiveness of physician-led telephonic outreach versus nurse-led email outreach at engaging patients to complete lung cancer screening. Methods This study was conducted at an urban integrated health system in Los Angeles. Eligible Medi-Cal beneficiaries enrolled in Kaiser Permanente coverage were identified through the electronic health record (EHR) using the 2021 USPSTF criteria for lung cancer screening: adults aged 50-80 years with ≥20 pack-year smoking history who currently smoke or have quit within the past 15 years. Patients currently undergoing annual screening or surveillance chest CT scans for other reasons were excluded. Scripted telephone outreach to patients was made by pulmonary physicians directly to engage in shared decision-making about lung cancer screening. LDCT was ordered upon patient consent to participate in screening. LDCT completion rate was compared with that obtained from historical nurse-led email outreach conducted 1 year prior. Results In total, 193 patients were identified by EHR as potentially screening-eligible. Contacts were successful in 115 respondents, amongst whom 5 declined to speak, 11 were ineligible based on confirmed smoking history, 15 declined screening, yielding 84 willing participants. Overall, 43/193 patients within cohort completed LDCT, significantly higher than the 34/665 patients in the nurse-driven email-based outreach (X2=54, p 0.0001). Based on multiple logistic regression analysis, screening participation was associated with older age. Neither gender, race, total pack-years of smoking, language, current smoking status, nor quit year correlated with propensity to screening participation. Actual completion of screening LDCT was also not affected by any of these variables. Our distribution of Lung-RADS results was comparable to national findings. There were two incidental findings requiring further workup. Conclusion Physician-led telephonic outreach may be more effective at increasing lung cancer screening participation than non-physician-led virtual encounters. Corresponding CT scan completion rate is improved as well, but remains suboptimal. Clearly, barriers exist that limit scan completion rates. Future efforts should target identification and elimination of such barriers to improve completion of scans among the willing participants. This abstract is funded by: None
Makhlouf et al. (Fri,) conducted a cohort in High-risk for lung cancer (n=858). Physician-led telephonic outreach vs. Historical nurse-led email outreach was evaluated on LDCT completion rate (p=<0.0001). Physician-led telephonic outreach significantly increased low-dose CT lung cancer screening completion compared to historical nurse-led email outreach (22.3% vs 5.1%; p<0.0001).