A stepped reminders intervention for primary care physicians and patients increased adherence to annual lung cancer screening (RR 1.58; 95% CI 1.46-1.72) relative to no reminders.
RCT (n=1,837)
factorial
No
Do health communication and stepped reminder interventions improve adherence to annual lung cancer screening in patients with normal index LDCT?
A stepped reminder intervention targeting both primary care physicians and patients significantly improves adherence to annual lung cancer screening.
Effect estimate: RR 1.58 (95% CI 1.46-1.72)
Absolute Event Rate: 78.1% vs 48.7%
Abstract Rationale For 10 years, the US Preventive Services Task Force has recommended annual lung cancer screening (LCS), with limited success in maintaining adherence to repeat screening. We tested two multilevel patient-centered interventions, designed to address multilevel barriers, to improve annual LCS adherence in a pragmatic clinical trial. Methods Trial population was 1,837 Kaiser Permanente Washington members aged 50-78 years with normal findings on index low-dose CT (LDCT) scan conducted from November 2022-April 2024. In a factorial design, participants were randomized to one of four arms: (1) usual care; (2) health communication intervention; (3) Stepped Reminders; or (4) both interventions. The health communication intervention targeted LCS knowledge gaps in print and video messaging, which emphasized the importance of routine LCS, provided a reminder to repeat LCS at 12 months, and incorporated elements of social support. The intervention was delivered through the electronic health record (EHR) portal and/or mail 3 weeks after index scan. The Stepped Reminders intervention provided reminders to primary care physicians (PCPs) and patients. About 4 weeks before repeat LDCT was due, PCPs received an order to sign, which initiated patient outreach through the EHR portal, mail and finally telephone to schedule the scan. All interventions were facilitated by EHR tracking and LCS coordinator. Participants were followed up to 15 months after index scan to measure adherence to annual LCS (screening LDCT in 9-15 month). Final analytic sample accounted for death, lung cancer diagnosis, chest CT, early LDCT, and disenrollment. An intent-to-treat analysis was used to estimate relative risks (RR) and 95% confidence intervals (CI) of intervention effects. Results Adherence to repeat screening was 48.7% in usual care, 46.1% in communication, 78.1% in reminders, and 72.8% in both interventions. The health communication intervention was associated with 7% decrease in LCS adherence (RR 0.93, 95% CI 0.87, 1.01) relative to no communication. The reminders intervention was associated with a 58% increase in LCS adherence (RR 1.58, 95% CI 1.46, 1.72) relative to no reminders. Discussion A multilevel healthcare system intervention of reminders to PCPs and patients resulted in clinically meaningful increased annual adherence to repeat screening. In decentralized screening programs, features of population health management such as reminders could improve LCS adherence. This abstract is funded by: National Cancer Institute (R01CA262015)
Wernli et al. (Fri,) conducted a rct in Lung cancer screening adherence (n=1,837). Stepped Reminders and/or Health communication intervention vs. Usual care was evaluated on Adherence to annual LCS (screening LDCT in 9-15 month) (RR 1.58, 95% CI 1.46-1.72). A stepped reminders intervention for primary care physicians and patients increased adherence to annual lung cancer screening (RR 1.58; 95% CI 1.46-1.72) relative to no reminders.