Providing Reminders and Education Prior to lung cancer screening: Feasibility and acceptability of a multilevel approach to address disparities in lung cancer screening.

Background: African American individuals experience disparities in the burden of lung cancer compared to other racial or ethnic groups. Yet, African Americans are less likely than White patients to have provider-initiated discussions about lung cancer screening (LCS). In addition to provider-level barriers, predictors of racial disparities include patient-level knowledge barriers and medical mistrust. This study assessed the feasibility and acceptability of provider- and patient-oriented approaches to increase uptake of LCS in a majority African American primary care clinic setting.

Methods: In Phase 1, we conducted surveys (N = 22) and usability testing with providers (N = 7) to develop a previsit planning message, a type of clinician reminder. The clinician reminder is sent via the electronic health record ahead of scheduled visits with screening-eligible participants to promote LCS discussion. We partnered with a primary care clinic (N = 5 providers; N = 399 patients 50-80 years old with a documented smoking history, no prior lung cancer diagnosis) to evaluate the impact of the reminder on LCS referral rates. In Phase 2, we conducted a pretest-posttest study (N = 16) to pilot a previsit phone-based patient education session. Patient-level LCS knowledge was assessed using 10 true/false items and a single item measured screening intentions.

Results: In Phase 1, LCS referrals increased from 6 6-months prepilot to 49 during the 6-month pilot period. The majority (89.8%) of the orders placed had a clinician reminder. In Phase 2, from pretest to posttest, there was improvement in LCS knowledge (mean percent correct: 63.3% to 76.7%; P = .013) and screening intentions (43.8% to 82%; P = .05).

Conclusions: In a diverse clinical setting, we developed a feasible and acceptable multilevel approach aimed at increasing LCS equitably.

Clinical trial information: The Clinical Trials Registration #NCT04675476.