Co-Development, Evaluation, and Dissemination of a Lung Cancer Screening Digital Outreach Intervention: A Multiphase Randomized Clinical Trial.

Abstract

Individuals from low-socioeconomic status (SES) communities experience worse lung cancer outcomes and multilevel barriers to lung cancer screening (LCS). Digital interventions may bridge LCS barriers. In this study, a three-phase design was used to rigorously develop, evaluate, and disseminate a digital outreach intervention to promote LCS among individuals from low-SES communities. In phase 1, focus groups were conducted with primary care providers (n = 12), patient advocates (n = 8), and patients who had (n = 7) and had not undergone LCS (n = 8). Focus groups explored barriers and facilitators to LCS and guided the development of three LCS outreach videos, which differed by message source (radiologist, patient, or both). In phase 2, LCS-eligible individuals from a national sample (n = 315) were randomized 1:1:1 to evaluate the videos. Logistic regression analyses were conducted to quantify the association between outreach video and intent to talk to a provider about LCS. In phase 3, 636 participants due for LCS with Medicaid received the outreach video via patient portal or text or email. Reach of the intervention and 12-month LCS follow-up rates were measured. In phase 1, participants cited fear of lung cancer and confusion about LCS eligibility criteria. In phase 2, there were no significant differences in intent to speak to a provider about LCS by outreach video type. In phase 3, a significantly greater proportion of participants reached by the intervention had scheduled or completed LCS than those not reached (32.4% vs 23.2%, P = .041). Participants who were reached by the digital outreach intervention codeveloped and disseminated to patients from low-SES communities were more likely to complete LCS.