‘Direct-to-patient’ digital prompt boosts CT lung cancer screening uptake
A digital prompt, delivered directly to individuals in the patient portal, can help boost lung cancer screening use, according to new research published Monday in JAMA.
Numerous studies have charted poor low-dose CT uptake for the disease, with rates as low as 20% among those eligible, one study found. Researchers with two academic health systems recently tried a new approach—reaching patients electronically outside of a regular doctor’s appointment and asking them to request a screening.
Called the mPATH Lung program—which also includes an informational aid to help with the decision—researchers recently tested its impact in a randomized trial. They founded “modest” gains in imaging uptake, calling for further exploration of the model.
“Compared with enhanced usual care, a direct-to-patient digital health intervention increased rates of lung cancer screening,” David P. Miller, MD, MS, with the Department of Implementation Science at Wake Forest University School of Medicine, Winston-Salem, North Carolina, and co-authors concluded. “Future research should assess the reach and effectiveness of digital lung cancer screening interventions across diverse populations and healthcare settings.”
For the study, researchers contacted nearly 27,000 individuals with a smoking history in their electronic health record. The final sample included 1,333 patients who were eligible and enrolled in the study, at an average age of 61. About half (669) were randomly assigned to the intervention group while the rest (664) received “enhanced usual care.” With the latter, the study’s website advised patients that they qualified for lung cancer screening and urged them to contact a primary care physician to set up an appointment. To ensure a similar level of engagement between both groups, the control arm also viewed a five-minute video about exercising to improve lung health.
Meanwhile, those in the mPATH Program viewed a three-minute animated clip about the potential benefits and harms of cancer screening. Next, they completed an exercise that helps estimate their personalized potential impact of completing low-dose CT imaging. And finally, mPATH urged individuals to request an appointment. Those who declined were given the lung cancer clinic’s contact info, in case they reconsidered. The program generated a one-page summary including each patient’s tobacco history, personalized risk-benefit assessment, screening decision, and more. Clinicians also conducted a shared decision-making telehealth visit, ordered screening if requested and managed results, per their usual practice.
Chest CT completion was higher in the mPATH group at 16 weeks (24.5%) when compared to the control arm of the study (17%). This represented a roughly 60% increase in the odds of someone completing screening, the authors estimated. Among patients who underwent imaging, false-positive results occurred in about 13% (19/150) versus 8% (8/95) in the control group. Invasive procedures were performed in 2% of the intervention group compared to 1% in the control.
“Although the intervention increased screening rates to nearly one-quarter of eligible individuals, this remains well below uptake levels achieved for other cancer screenings,” experts wrote in a corresponding editorial published Oct. 20. “Moreover, the intervention’s overall reach was modest—only 12% of those invited completed the eligibility assessment, highlighting the need for more expansive and inclusive approaches to promote equitable access to lung cancer screening. The results illustrate the complexity of the lung cancer screening pathway, from initial awareness of eligibility to completion of the CT scan, and the challenges of maintaining engagement at each step.”
Read more, including potential study limitations, in the Journal of the American Medical Association, which also published a separate summary of the study’s key findings.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.