Ready to Screen Trial - A trial of lung cancer screening recruitment strategies

The National Lung Cancer Screening Program (NLCSP) will commence in Australia from July 2025. Program participants are expected to be referred by their general practitioner (GP) to take part in this targeted screening program and it is crucial to evaluate optimal recruitment strategies for those individuals who will be eligible. The Ready To Screen trial seeks to explore whether participant intention to participate in the NLCSP is influenced by the provision of a different implementation strategy incorporating personalised invitations sent by a GP, receiving lung cancer screening information and offering a variety of participation pathways into program. The Ready to Screen trial aims to test a bundled implementation strategy (against a simple implementation strategy) delivered via primary care practices to increase patient intention to screen for lung cancer in the upcoming NLCSP. General practices assigned to the intervention arm will receive the Bundled Implementation Strategy including the core components (see Control condition) and five additional components: 1) Core component (as in control arm) – Initial letter mailout via standard mail or email including a co-designed brochure and invitation to participate in the R2S trial, AND 2) URL link to a “Ready To Screen” multilingual website where patients can learn more about lung cancer screening and calculate their eligibility for screening using an embedded smoking history calculator; AND 3) First reminder sent via Short Message Service (SMS) sent 2 weeks following the initial letter, directly to their mobile phone; AND 3) Second reminder sent via letter/email, sent 4 weeks following the initial invitation letter; AND 5) Co-designed posters displayed within their practice setting that will include a QR code and URL link to a Ready To Screen website. This includes posters in multiple community languages with links to the R2S website that contains translated materials; AND 6) Future Health Today (FHT) clinical decision support system features turned on prompting GPs to consider discussing NLCSP/update patient smoking history for patients flagged in the system as potentially eligible (Practice opt-in component). The trial period will last six months. The intervention period will span three months, during which GP practices will implement the strategy in their practice and then data will be collected over additional three months. Adherence to the intervention will be monitored by service use data recorded by the research nurse (type, frequency, and duration of intervention components/invitations disseminated/utilised by practices) and participant self-reported data (proportions of service users receiving/responding to the invitations). Practice administrator/delegate will receive a once-off training provided by FHT developers (Department of General Practice, The University of Melbourne) in the use of FHT platform. The training will upskill general practice administrators to prepare lists of patients potentially eligible for screening and contact eligible patients informing them about the upcoming NLCSP (see intervention component #6 above). The practice administrators will use FHT (or any other compatible patient record management tool) to generate a list/report to identify potentially eligible participants. The eligible patient list will be reviewed for exclusions. The initial invitation letters and the subsequent reminders will be sent by the practice administrator, with support provided by the research nurse. Prior to delivery of the intervention, all GPs in the practices enrolled in the intervention group will receive a 1-hour telehealth educational (CPD-accredited) training delivered by the research team. The CPD training will: • Upskill GPs in their knowledge of lung cancer, screening, referral and diagnosis; • Train GPs to navigate the NLCSP recommendations, identify eligible patients, provide advice and refer to screening; and • Train GPs is how to update/record their patients’ smoking history and calculate smoking-history duration (i.e., pack years).