Co-development, evaluation, and dissemination of a lung cancer screening digital outreach intervention: A multiphase randomized clinical trial.

Abstract

Background: 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. This study employed a three-phase design to rigorously develop, evaluate, and disseminate a digital outreach intervention to promote LCS among individuals from low SES communities.

Methods: Phase 1: Focus groups (FG) were conducted with primary care providers (n=12), patient advocates (n=8), and patients who had (n=7) and hadn't undergone LCS (n=8). FG explored barriers and facilitators to LCS and guided the development of 3 LCS outreach videos, which differed by message source (radiologist, patient, or both). Phase 2: LCS-eligible individuals from a national sample (N=315) were randomized 1:1:1 to evaluate the videos. Logistic regression analyses quantified the association between outreach video and intent to talk to a provider about LCS. Phase 3. 636 participants due for LCS with Medicaid received the outreach video via patient portal or text/email. Reach of the intervention and 12-month LCS follow-up rates were measured.

Results: Phase 1: Participants cited fear of lung cancer and confusion about LCS eligibility criteria. Phase 2: There were no significant differences in intent to speak to a provider about LCS by outreach video type. Phase 3. A significantly greater proportion of participants reached by the intervention had scheduled/completed a LCS than participants not reached (32.4% vs. 23.2%, p=.041).

Conclusions: Participants who were reached by the digital outreach intervention co-developed and disseminated to patients from low SES communities were more likely to complete LCS.