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Using Digital Outreach to Identify Individuals Eligible for Lung Cancer Screening: A Secondary Analysis of a
Richa Bundy1, Anna C Snavely2, David P Miller3
1Informatics and Analytics, Department of Internal Medicine, Advocate Health, Wake Forest University School of Medicine, Winston Salem, NC, USA. richa.bundy@advocatehealth.org.
Background:
Lung cancer is the third most common cancer in the United States, but screening rates among high-risk adults remain low. In a multisite randomized trial conducted in two large academic health systems in North Carolina, we found that a digital health intervention delivered to patients at home increased lung screening (LCS) rates. While LCS reduces mortality, identifying and reaching eligible patients is challenging and limits screening uptake.
Objective:
This study examines the reach of a digital health outreach strategy for determining eligibility for LCS.
Design:
A secondary analysis of a pragmatic randomized trial.
Participants:
Individuals aged 50 to 77 with a history of cigarette smoking received an invitation to use the digital health program at two academic health systems in North Carolina.
Main Measures:
Reach of the engagement strategy overall and within demographic subgroups. Reach is defined by the proportion of patients completing LCS eligibility questions within 16 weeks of portal or text invitation.
Key Results:
Of 26,909 individuals invited, 3,049 (11%) completed LCS eligibility questions within 16 weeks of invitation. Reach was higher among females, those aged 50-64, individuals with high/medium socioeconomic status, those with commercial insurance, and urban residents. White participants had higher reach compared to Black and Hispanic participants (12.8% vs 8.6% and 8.0%). Within 16 weeks of invitation, portal messages were read by 65.5% of recipients, with 17.1% visiting the mPATH-Lung landing page. Sending text invitations to those not reachable by portal expanded reach by 604 participants (from 2,445 to 3,409), compared to portal invitations alone.
Conclusions:
This scalable outreach strategy engaged a large population for lung cancer screening. However, reach was found to be lower in historically underrepresented groups. Future strategies should continue leveraging multiple communication channels, including a cellphone text primary strategy, to maximize engagement and potentially improve equitable access to healthcare services.
Clinical Trial Registration:
ClinicalTrials.gov NCT04083859, registered September 10, 2019. Available at: https://www.
Clinicaltrials:
gov/study/NCT04083859.