LungCheck: Pilot Testing a Theory-Informed Multicomponent Strategy to Increase Lung Cancer Screening in Primary Care...

Lung cancer screening (LCS) with low-dose computed tomography (LDCT) reduces lung cancer-specific and all-cause mortality, yet uptake remains low. This study evaluates LungCheck, a theory-informed multicomponent behavior change and implementation strategy designed to increase LDCT ordering in two diverse primary care settings.

This pilot study compared 16-month pilot and pre-pilot periods at a federally qualified health center (FQHC) and an academic faculty practice in New York City. LungCheck comprised educational meetings, materials and clinician reminders, an implementation blueprint, patient navigation, and EHR modifications. LDCT ordering rates (primary outcome) were compared using generalized estimating equations (GEE). Post-implementation surveys assessed acceptability, appropriateness, and feasibility.

A total of 5,918 patient-period observations were included (1,569 academic; 4,349 FQHC). Among patients with documented LCS eligibility, the odds of LDCT ordering were significantly higher during the pilot at both the academic practice (OR, 2.67; 95% CI, 1.47-4.85; p=0.001) and FQHC (OR, 4.53; 95% CI, 2.29-8.94; p<0.001). A combined-site multivariable model adjusting for site, age, sex, and race confirmed higher odds of LDCT ordering during the pilot (OR, 1.95; 95% CI, 1.44-2.63; p<0.001). Among patients with an LDCT order, completion was 71.4% (10/14) pre-pilot versus 35.7% (15/42) during the pilot at the academic practice and 42.9% (18/42; 95% CI, 28%-59%) versus 39.3% (24/61; 95% CI, 27%-53%) at the FQHC. The strategy was rated as highly acceptable (AIM, 4.47/5), appropriate (IAM, 4.44/5), and feasible (FIM, 4.41/5).

LungCheck was associated with significantly increased LDCT ordering at both sites, high acceptability, feasibility, and appropriateness ratings and high provider knowledge, confidence, and perceived skills related to LCS. Although a corresponding improvement in LDCT completion was not observed, the small number of LDCT orders limited the precision of completion estimates. Persistent environmental and patient-level barriers underscore the need to adapt LungCheck into a multilevel intervention addressing patient-, provider, and system-level barriers across the LCS continuum, to be evaluated in a future cluster randomized trial.