Grant Details
Grant Number: |
5R01CA262015-04 Interpret this number |
Primary Investigator: |
Wernli, Karen |
Organization: |
Kaiser Foundation Research Institute |
Project Title: |
Multilevel Interventions to Increase Adherence to Lung Cancer Screening |
Fiscal Year: |
2024 |
Abstract
ABSTRACT
Screening for lung cancer has the potential for a profound public health benefit. Lung cancer is the leading
cause of US cancer morbidity and mortality for both men and women, responsible for more deaths than breast,
cervical, colorectal, and prostate cancers combined. Annual screening with low-dose computed tomography
(LDCT) reduced lung cancer mortality by 20%. Successful population-based screening requires continuous
monitoring to adherence repeat screening in high risk adults to achieve similar results. Repeat annual
screening is necessary for early detection of lung cancer. Baseline or first LDCT scans detect prevalent lung
cancer, when subsequent screening detects new nodules. However, adherence to screening is low, ranging at
28-38% from centers nationally. Multilevel interventions, which target patients, clinicians, and healthcare
systems, offer a promising framework to address the gaps in lung cancer screening to achieve guideline-
recommended lung cancer screening. Our mixed-methods pilot study with KPWA stakeholders two critical
components to improve adherence to repeat screening: providing education for patients on lung cancer
screening, and offering reminders for on-time return to screening. We developed two novel patient-centered
interventions using principles of human-centered design to address these needs: 1) Patient Voices Video that
incorporates patient testimonials to acknowledge receipt of screening, a tailored reminder of time due for next
scan, and reassurance to reduce fear of screening and role of loved ones to support health choices; and 2)
Stepped Reminders, that directly reminds patients when their next scan is due. Both interventions are
facilitated by a health system electronic health record (EHR) build to track patients for population health
management and a clinically-embedded medical assistant to deliver interventions. The goal of this proposal is
to test these two interventions relative to usual care to promote adherence to repeat screening in a pragmatic
cluster randomized trial enrolling 1775 adult KPWA members, who complete a screening LDCT in 2022-2025
across 34 KPWA primary care clinics in a 2x2 factorial-designed study. Study arms include: a) Stepped
Reminders alone; b) Patient Voices Video alone; c) both interventions; or d) usual care. To address our goals,
our specific aims are to: 1) Compare effectiveness of two multilevel interventions relative to usual care in
improving (a) rates of adherence to lung cancer screening, (b) patient-centered outcomes; and (c) clinic
outcomes; and 2) Determine the patient-, clinician-, and system-level factors that influence changes in
adherence to inform lung cancer screening programs. To date, no randomized clinical trial has evaluated
strategies to improve adherence to lung cancer screening in US populations with multilevel strategies. We will
move the field forward by providing effective, scalable interventions to improve lung cancer screening
adherence to achieve the population-based mortality benefits promised by large clinical trials that motivated
screening guidelines.
Publications
A pragmatic randomized clinical trial of multilevel interventions to improve adherence to lung cancer screening (The Larch Study): Study protocol.
Authors: Luce C.
, Palazzo L.
, Anderson M.L.
, Carter-Bawa L.
, Gao H.
, Green B.B.
, Ralston J.D.
, Rogers K.
, Su Y.R.
, Tuzzio L.
, et al.
.
Source: Contemporary Clinical Trials, 2024 May; 140, p. 107495.
EPub date: 2024-03-11 00:00:00.0.
PMID: 38467273
Related Citations