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Health Communication and Stepped Reminders Interventions for Lung Cancer Screening: A Randomized Clinical Trial
Karen J Wernli1,2,3, Melissa L Anderson1, Lorella Palazzo1
1Kaiser Permanente Washington Health Research Institute, Seattle.
JAMA Internal Medicine
|August 10, 2026
Summary
Stepped reminders for primary care physicians and patients significantly improved adherence to annual lung cancer screening (LCS). This intervention, particularly effective for current tobacco users, enhances screening rates in PCP-led programs.
Area of Science:
- Public Health
- Clinical Trials
- Preventive Medicine
Background:
- Annual lung cancer screening (LCS) is recommended by the US Preventive Services Task Force, but adherence remains low.
- Low adherence limits the effectiveness of LCS in reducing lung cancer mortality.
Purpose of the Study:
- To evaluate two multilevel, patient-centered interventions aimed at increasing adherence to guideline-concordant annual LCS.
- To compare the effectiveness of health communication and Stepped Reminders interventions, individually and in combination.
Main Methods:
- A pragmatic 2x2 factorial randomized clinical trial involving patients who completed an initial LCS with normal findings.
- Interventions included usual care, health communication (print/video messaging), Stepped Reminders (pending orders, patient outreach), or both.
- Primary outcome was the completion of a follow-up low-dose computed tomography (LDCT) scan 9-15 months after the initial scan.
Main Results:
- The Stepped Reminders intervention increased adherence by 27.7 percentage points (RR, 1.59; P<.001), while health communication decreased adherence by 4.7 percentage points (RR, 0.93; P=.04).
- Stepped Reminders showed greater improvement in screening rates among current tobacco users compared to former users (P interaction=.03).
- Overall adherence was 75.5% in the Stepped Reminders group versus 47.4% in the no Stepped Reminders group.
Conclusions:
- Multilevel reminders directed to primary care physicians (PCPs) and patients effectively improve adherence to annual LCS.
- The Stepped Reminders intervention is a successful strategy for enhancing LCS adherence in PCP-led screening programs.
- Targeted interventions are crucial for overcoming barriers to consistent LCS participation.
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