Abstract A122: Development and pilot testing of an EHR-based provider-level intervention to promote equity in lung cancer screening
Authors: Williams Randi M. , Whealan Julia , Blumenthal Joseph , Foley Kristie , Taylor Kathryn L. , Adams-Campbell Lucile , Miller Kristen E. , Barnes Rachelle , DuBoyce William F. , Kratz Heather , Lin Kenneth W. 
Published: January 2023

Introduction: Black/African Americans (AA) have the highest lung cancer incidence and mortality compared to other racial and ethnic groups; however, provider-initiated discussions with eligible patients about lung cancer screening (LCS) are low overall, and AA and other minority individuals are less likely than Whites to have these discussions. To target lack of provider-initiated discussion about lung screening, we describe the development and feasibility of a provider-level prompt for a planned multilevel intervention to promote equitable uptake of LCS. Methods: We used an iterative process to refine a provider prompt delivered in the Electronic Health Record (EHR; Cerner Health). First, we conducted surveys with MedStar Health primary care providers (N=22) to examine existing system tools for identifying screen-eligible patients, design-related provider preferences (e.g., content, format), and delivery and usefulness of the prompt (e.g., timing, likelihood of prompting LCS discussion). Next, we completed shadowing (N=11 visits) to observe the primary care clinic workflow. We conducted usability testing (N=7) to finalize the prompt. We partnered with a MedStar Primary Care Clinic (Mitchellville, MD) to evaluate the feasibility of implementing the prompt over a 6 month period. Utilizing an automated report to identify patients (50-80 years with a smoking history) with an upcoming visit, we sent the prompt to providers prior to the visits to notify them of the patient’s possible eligibility and encourage discussion of the test. Results: Of the providers who completed the survey, the majority were attending physicians (81.8%). Providers were shown a mock-up and 95% reported it was enough information to prompt them to have a discussion with their patients. Most (86.4%) said the optimal time to receive the prompt would be within 24 hours of the visit. During the usability testing, providers were given two formats and patient scenarios and they identified content that should be removed (e.g., screenshots of how to place the order, repeated hyperlinks). Most preferred the patient smoking history presented in a tabular format and liked the addition of color for visual appeal. In the 12-month period pre-intervention, the pilot clinic patient population (N=1223) were majority AA (91%) and over 90% were missing complete pack-year data (required for LCS eligibility). During the pilot period, 64% of records were eligible for the provider prompt and 45% of patients' pack-year data were updated post-appointment. Conclusions: These findings describe a promising provider-level intervention to identify patients and prompt provider-initiated discussion about smoking history and LCS. As a next step, we will evaluate the impact of the prompt on LCS orders. We will also pilot a patient-level intervention to improve provider-patient communication about screening. We intend to look at the effect of these combined interventions on LCS behaviors among AA and White patients.

Citation Format: Randi M. Williams, Julia Whealan, Joseph Blumenthal, Kristie Foley, Kathryn L. Taylor, Lucile Adams-Campbell, Kristen E. Miller, Rachelle Barnes, William F. DuBoyce, Heather Kratz, Kenneth W. Lin. Development and pilot testing of an EHR-based provider-level intervention to promote equity in lung cancer screening [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A122.