Multilevel Interventions to Increase Adherence to Lung Cancer Screening

Study Overview
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Brief Summary
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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
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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.

Official Title
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Multilevel Interventions to Increase Adherence to Lung Cancer Screening

Conditions
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Lung Cancer, Lung Cancer Screening

Intervention / Treatment
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* Other: Stepped Reminders
* Other: Patient Education


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 50 Years
Maximum Age: 78 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Patient Video only<br>About 3 weeks after the index LDCT, the study Medical Assistant (MA) will deliver a link to the Patient Voices Video, an educational video about lung cancer screening. | Other: Patient Education<br>* The Patient Voices Video is an educational video about lung cancer screening.<br>|
| Experimental: Stepped Reminders only<br>Prior to patient's next LDCT scan is due, MA begins Stepped Reminders intervention: MA pends LDCT orders to PCP to sign. MA sends reminders to patient when order is placed and follows up by phone if patient has not scheduled LDCT. | Other: Stepped Reminders<br>* 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.<br>|
| Experimental: Patient Video and Stepped Reminders<br>See above. Those assigned to the Patient Video and Stepped Reminders will receive both interventions, as described above. | Other: Stepped Reminders<br>* 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.<br>Other: Patient Education<br>* The Patient Voices Video is an educational video about lung cancer screening.<br>|
| No Intervention: Usual Care<br>Those assigned to the the Usual Care arm will continue to receive usual lung cancer screening care. | |

What is the study measuring?
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Primary Outcome Measures

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

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Knowledge of lung cancer screening | Knowledge of lung cancer screening eligibility, time to return and cost on patient reported outcomes survey. | 8 weeks after index LDCT | 
| Attitudes and beliefs | The Lung Cancer Screening Health Belief Scales: 1) perceived risk of lung cancer (3 items); 2) perceived benefits of lung cancer screening (6 items); (3) perceived barriers to lung cancer screening (17 items); and (4) self-efficacy for lung cancer screening (9 items). | 8 weeks after index LDCT | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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User centered design, Lung Cancer, Low dose CT (LDCT), Lung Cancer Screening, Stepped Reminders, Educational Video, Stakeholders, Evaluation, Qualitative, Patient Partners, Adherence