A multilevel approach to improve participation in low-dose CT for lung cancer screening (Empower LCS): A single-arm pilot feasibility clinical trial

BACKGROUND: Lung cancer screening (LCS) uptake remains low nationally. We evaluated the feasibility and preliminary efficacy of a multilevel intervention to improve LCS uptake in a pilot trial. 

METHODS: Eligible patients were 50 to 80 and met 2021 United States Preventive Services Task Force LCS criteria. The Empower LCS intervention included (1) a decision aid; (2) a text reminder to encourage LCS discussion with primary care providers (PCPs); (3) PCP notifications on eligibility and barriers, and (4) financial hardship and health-related social needs support. Screening outcomes (LCS discussions, orders, and completion) at 6 months were assessed using medical records and surveys. Changes in LCS knowledge and health beliefs were assessed with surveys. 

RESULTS: In all, 70 patients enrolled (mean age: 62.5 ± 6.3; 70% male; 1.4% Black, 18.6% Asian, 44.3% White, 35.7% other); 45.7% were Hispanic, and 41% were current smokers. Common LCS barriers included cost concerns (40%, 28 of 70) and fear of finding something wrong (34.3%, 24 of 70). All received the decision aid, text reminder, and PCP alert. Of the patients, 72.9% reported financial hardship or health-related social needs and received support. At 6 months, 71.4% (50 of 70) discussed LCS with their PCP, 51.4% (36 of 70) received low-dose CT orders, and 27.1% (19 of 70) completed screening (52.8% of those with order). Completion exceeded the national average of 16% (P = 0.01). Knowledge and perceived severity changed significantly (knowledge: from 1.91 to 2.67, P = .01; severity: from 16.3 to 18.1, P = .0003). No significant changes were observed in perceived barriers or self-efficacy. 

CONCLUSION: The Empower LCS intervention was feasible and improved LCS uptake. However, only half of those with LCS order, completed screening, suggesting the need for enhanced navigation.