A study published in JAMA Internal Medicine found that sending stepped reminders to physicians and patients four weeks before their annual screening due date increased lung cancer screening adherence by nearly 28 percentage points, with 75.5% of participants completing their screening compared to 47.4% without the intervention.
- 28-percentage-point increase: Stepped reminders boosted annual CT lung cancer screening adherence from 47.4% to 75.5% among participants
- Timing matters: Reminders were delivered four weeks before each patient's annual screening due date to both physicians and patients
- Current smokers benefit most: Tobacco users saw a 32.3-percentage-point improvement in screening adherence with reminders, compared to 24.1 points for former smokers
- National gap remains: Despite USPSTF recommendations for over a decade, national lung cancer screening adherence stays between 22-50%, well below trial rates
- Study details: Kaiser Permanente Washington enrolled 1,837 patients with normal or benign LDCT findings from November 2022 to April 2024
Annual CT lung cancer screening rose by nearly 28 percentage points when physicians received pending scan orders and patients received direct scheduling outreach, according to a study published August 10 in JAMA Internal Medicine.
A group from Kaiser Permanente Washington in Seattle evaluated two multilevel interventions to increase adherence to recommended annual low-dose CT (LDCT) lung cancer screening, with findings suggesting that system-level reminders directed at physicians and patients can effectively improve rates in primary care-led programs, noted lead author Karen Wernli, PhD, and colleagues.
“Appropriately timed Stepped Reminders delivered 4 weeks prior to the annual due date to both [primary care physicians] and patients were clinically effective at improving adherence to guideline-concordant annual [lung cancer screening],” the group wrote.
While the U.S. Preventive Services Task Force has recommended annual lung cancer screening with LDCT for more than a decade, national adherence remains between 22% and 50%, well below rates seen in the trials that established the modality's mortality benefit, the authors wrote. To date, multilevel interventions to address barriers to adherence to annual screening have yet to be tested in clinical trials, they added.
To bridge the gap, the group enrolled 1,837 patients with recent normal or benign LDCT findings at Kaiser Permanente Washington from November 2022 to April 2024. Participants were randomized to receive health communication, Stepped Reminders, both, or neither. Participants in the health communication arm received portal messages, including videos and mailed letters on annual screening importance and return timing. The Stepped Reminders intervention pended LCS scan orders for primary care physicians four weeks before each patient's due date and sent outreach to patients to remind them to schedule scans. The primary outcome was screening LDCT or chest CT completion nine to 15 months after the index scan.
According to the results, Stepped Reminders increased screening adherence by 27.7 percentage points: 75.5% of those who received the intervention completed their annual scan compared with 47.4% who did not (relative risk, 1.59; p < 0.001). Health communication was associated with a 4.7-percent point decline in adherence relative to no communication (59.2% versus 63.3%; p = 0.04).
In addition, the Stepped Reminders benefit was significantly larger among patients currently using tobacco. Adherence among this group rose by 32.3 percentage points (73.0% versus 41.2%) compared with a 24.1-percentage point gain among former tobacco users (77.8% versus 52.9%; p = .03).
“Our trial findings directly address the current lack of effective [lung cancer screening [LCS]) interventions to increase LCS adherence,” the authors wrote.
Integrating intentional, multilevel reminders into LCS workflows may be essential for achieving the population-level mortality benefit of screening in primary care physician-led programs, the researchers concluded.
Read the full study here.
