Multilevel Interventions to Increase Adherence to Lung Cancer Screening

Conditions

Lung Cancer, Lung Cancer Screening

Keywords

Lung Cancer, Low dose CT (LDCT), Lung Cancer Screening, Stepped Reminders, Educational Video, User centered design, Stakeholders, Evaluation, Qualitative, Patient Partners, Adherence

Brief summary

Screening for lung cancer has the potential for a profound public health benefit. Repeat annual screening is necessary for early detection of lung cancer. The investigators will test two interventions which include patient education and reminders to improve adherence to lung cancer screening.

Detailed description

Screening for lung cancer has the potential for a profound public health benefit. Successful population-based screening requires continuous monitoring to adherence repeat screening in high risk adults to achieve similar results. Repeat annual screening is necessary for early detection of lung cancer. Baseline or first LDCT scans detect prevalent lung cancer, when subsequent screening detects new nodules. However, adherence to screening is low, ranging at 28-38% from centers nationally. The investigators developed two novel, patient-centered interventions to address patient education and offering reminders for on-time screening. To address these goals, the specific aims are to: 1) Compare effectiveness of two multilevel interventions relative to usual care in improving (a) rates of adherence to lung cancer screening, (b) patient-centered outcomes; and (c) clinic outcomes; and 2) Determine the patient-, clinician-, and system-level factors that influence changes in adherence to inform lung cancer screening programs.

Karen J. Wernli, Melissa L. Anderson, Lorella Palazzo, Casey Luce, Nadejda Bezman et al. (15 authors)

JAMA Internal Medicine2026-08-10

10.1001/jamainternmed.2026.3666

Understanding older adults’ perceptions and attitudes toward digital health and technology in a lung cancer screening-eligible population: a qualitative study

Anjali Vasavada, Lorella Palazzo, Casey Luce, Magali Sanchez, Triplette Matthew et al. (14 authors)

BMC Health Services Research2026-07-21

10.1186/s12913-026-15124-7

Effectiveness of Health Communication Intervention to Improve Knowledge on Timeliness to Return for Annual Lung Cancer Screening: The Larch Trial.

Wernli KJ, Anderson ML, Palazzo L, Luce C, Bezman N, Chin M, Gao H, Ralston JD, Rogers K, Su YR, Triplette M, Carter-Bawa L, Vasavada A, Jordan M, West M, Boler S, Green BB.

2025-09-10

10.1016/j.chest.2025.07.4111

A pragmatic randomized clinical trial of multilevel interventions to improve adherence to lung cancer screening (The Larch Study): Study protocol.

Luce C, Palazzo L, Anderson ML, Carter-Bawa L, Gao H, Green BB, Ralston JD, Rogers K, Su YR, Tuzzio L, Triplette M, Wernli KJ.

2024-03-114 citations

10.1016/j.cct.2024.107495

Interventions

OTHERStepped Reminders

Stepped Reminders, which directly reminds providers to order the next LDCT scan and then reminds patients they are due and prompts them to schedule LDCT with Radiology.

OTHERPatient Education

The Patient Voices Video is an educational video about lung cancer screening.

Study design

Allocation

RANDOMIZED

Intervention model

FACTORIAL

Primary purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Eligibility

Sex/Gender

ALL

Age

50 Years to 78 Years

Healthy volunteers

No

Inclusion criteria

* KPWA members * Aged 50-78 years * Have a negative screening LDCT scan * Speak English or Spanish * Meet US Preventive Services Task Force guidelines

Exclusion criteria

* Patients who were previously diagnosed with lung cancer, * Patients who have a positive scan, * Patients who have an indicator for interpreter services, except for Spanish

Design outcomes

Primary

Measure	Time frame	Description
Rate of repeat annual lung cancer screening	9-15 months after index LDCT	Electronic health records will be searched for screening low dose CT (LDCT).

Secondary

Measure	Time frame	Description
Knowledge of lung cancer screening	8 weeks after index LDCT	Knowledge of lung cancer screening eligibility, time to return and cost on patient reported outcomes survey.
Attitudes and beliefs	8 weeks after index LDCT	The Lung Cancer Screening Health Belief Scale measures self-efficacy for lung cancer screening. The self-efficacy for lung cancer screening scale ranges from 9-36, with higher scores indicating lower self-efficacy.

Countries

United States

Outcome results

None listed