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Increasing Uptake of Lung Cancer Screening Through a Patient Nudge: A Randomized Pragmatic Trial
Nikki M Carroll1, Andrew J Maclennan2, Kris F Wain1
1Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado.
Introduction:
Population-level benefits of lung cancer screening depend on high participation, yet uptake remains low because of patient-, provider-, and system-level barriers. This study evaluated whether a previsit patient nudge increases lung cancer screening uptake.
Study Design:
Patients were randomized by birth month into intervention and usual care groups.
Setting/Participants:
Kaiser Permanente Colorado patients eligible for lung cancer screening who had not completed baseline lung cancer screening low-dose computed tomography screening and had a scheduled primary care physician visit between March 19, 2024 and October 8, 2024 were randomized. Data were collected through November 20, 2024.
Intervention:
Patients in the intervention group received an electronic or mailed letter encouraging lung cancer screening discussion with their primary care physician.
Main Outcome:
Receipt of lung cancer screening low-dose computed tomography order.
Results:
Analyses were conducted from 2024 to 2026. A total of 894 patients were randomized: 456 (51%) to intervention group and 438 (49%) to usual care group. Overall, 728 completed their visit (359 [49%] intervention group and 369 [51%] usual care; p=0.69). Among those completing their visit, same-day lung cancer screening low-dose computed tomography ordering was similar (15% vs 18%; p=0.30), as were lung cancer screening low-dose computed tomography completion rates (7.0% vs 7.2% of completed visits [p=0.92]; 39% vs 48% of orders [p=0.34]). By the end of follow-up, more usual care patients had received lung cancer screening low-dose computed tomography orders (41% vs 38%; p=0.36).
Conclusions:
A low-intensity previsit patient nudge did not increase lung cancer screening low-dose computed tomography orders but was feasible to implement and allowed outreach strategy adaptations. Future refinements should optimize timing and integrate outreach with existing patient communications, such as appointment reminders, to improve patient reach and engagement in patient-provider shared decision making discussions.
Trial Registration:
This study was registered at www.
Clinicaltrials:
gov (NCT06474611).
