I need it. Without it, I wouldn't have gone, and I do want to go: patient perspectives on the acceptability and appropriateness of two patient-centered interventions to improve adherence to annual lung cancer screening.

Abstract

Introduction: Low adherence to annual lung cancer screening (LCS) has tempered mortality benefits in clinical practice. Herein, we assessed the acceptability and appropriateness of two patient-centered interventions addressing adherence barriers to annual LCS.

Methods: Participants were Kaiser Permanente Washington members, aged 50-78 years, who participated in a pragmatic randomized trial ("The Larch Trial"). The trial tested: (1) health communication including a video to improve patient knowledge of timeliness to return; and (2) outreach reminders to patients to schedule annual screenings after their primary care provider (PCP) ordered a scan without an appointment. Participants, randomly sampled on sex, race/ethnicity, tobacco status, and trial arm, completed semistructured, virtual interviews that lasted for 60 min. The interviews explored intervention acceptability and appropriateness, and barriers and facilitators to both. Transcripts were analyzed using a rapid group analysis process informed by the Consolidated Framework for Implementation Research. Identified themes were second-coded for acceptability and appropriateness in accordance with the Implementation Outcomes Framework.

Results: A total of 32 participants were interviewed; 66% were non-Hispanic white, 53% male, and 53% currently use tobacco. The participants found the interventions acceptable and appropriate with variations by LCS history and information needs. Some participants found the video helpful and comforting, especially first-time screeners. Other participants, particularly those engaged in annual LCS, found that the video lacked new information. The participants strongly endorsed the reminder intervention for encouraging LCS and clarifying the timing of repeat screening. Most participants endorsed the annual screening scan ordered without a PCP visit. The participants preferred the multimodal delivery of reminders for reinforcement. Facilitators of acceptability and appropriateness included video design and perceived educational value, and an electronic health record ecosystem supporting communication aligned with routine practice. Barriers included content perceived as not novel, lack of information to address specific needs, and excessive reminders.

Discussion: Video-based content in LCS is generally acceptable and appropriate to patients if tailored by LCS history. Patient outreach reminders are acceptable and appropriate when mirroring other healthcare system communications. Participants already engaged in LCS did not feel they needed to see their PCP one year later for repeat screening (within 1 year). Future studies should test interventions in other populations and healthcare systems using different communication strategies.

Clinical trial registration: clinicaltrials.gov, identifier #NCT05747443.