Patients' and providers' perspective of a multi-level approach to improve participation in low-dose CT for lung cancer screening (Empower LCS): A mixed-methods analysis

RATIONALE AND OBJECTIVES: Lung cancer screening (LCS) utilization remains suboptimal. We examined the experience of patients and primary care providers (PCPs) participating in a multilevel intervention addressing LCS barriers. 

METHODS: Empower LCS is a single-arm pilot feasibility trial evaluating feasibility, acceptability and potential impact of a multilevel intervention, including a decision aid, patient reminders, PCP electronic medical record (EMR) notifications, and support for health-related social needs (HRSNs) for patients screening positive for HRSNs, to improve LCS completion. Using a mixed-methods design, quantitative surveys assessed the helpfulness of intervention components. Additionally, 11 patients and five PCPs participated in 30-minute semi-structured interviews, analyzed through a theoretically driven thematic approach. 

RESULTS: Of 70 participants, 41 completed experience questions at 6-months (mean age 61.7 ± 6.4; 63.4% male). Most patients found the intervention helpful: 61.5% (24/39) decision aid, 67.5% (27/40) patient reminder, and 70.7% (29/41) PCP's EMR notification. Most patients viewed LCS as important and wanted to discuss it with their provider. However, some patients felt providers were hesitant to engage fully or lacked knowledge about LCS eligibility. Patient-reported barriers included scheduling challenges, insurance delays, and smoking-related stigma. Many said Empower LCS increased awareness and motivation. Providers reported routinely discussing smoking history and identified low patient awareness, insurance issues, competing priorities, and patient radiation concerns as barriers. They found the intervention appropriate for primary care, especially with better patient education and EMR notifications. 

CONCLUSION: Both patients and providers were receptive to LCS and thought the Empower LCS intervention had the potential to increase LCS in routine practice.