Prior Lung Cancer Screening Awareness and Patient-reported Proposed Interventions

Purpose: The current U.S. Preventive Services Task Force (USPSTF) guideline recommends annual Low Dose Lung CT (LDCT) scans for lung cancer screening (LCS) in individuals aged 50 to 80 with a smoking history of 20 pack-years, who are current smokers or have quit within the last 15 years. However, LCS uptake among eligible individuals in the US is low at 5.8%. Our objective was to investigate patient-reported interventions for improving LCS uptake based on their history of LCS awareness and adherence.

Methods/Materials: Between May and November 2023, patients meeting USPSTF LCS criteria without a history of lung cancer and no previous LDCT scan in the last 12 months who had a primary care encounter in our institution during the past year were invited to complete a 15-minute survey either online or via phone. Questions included prior discussion of LCS with primary care provider (PCP), history of LCS, and patient-proposed interventions to increase LCS uptake.

Results: A total of 85 eligible patients (mean age: 62.5; 57.6% male; 78.8% White, 11.8% Hispanic, 4.7% Asian) participated, with 69.4% being former smokers. Despite being eligible to receive LCS, 64.7% never discussed LCS with their PCP. Among 35.3% who did discuss, only 20.7% had undergone prior screening. Older patients had higher odds of discussing LCS (OR:1.14, 95% CI:1.04-1.26).
Among patients with prior LCS, 50% preferred text reminders and 33.3% phone reminders. Among patients who discussed LCS with their provider but were not screened, 60.9% suggested automatic PCP reminders about patient eligibility are most beneficial, followed by patient reminders (52.2% text and 47.8% phone). Among patients who never discussed LCS, 60% recommended automatic reminders to PCP, 49.1% recommended text reminders, and 41.8% recommended online educational videos via the patient portal.

Conclusions: Annual LCS can be difficult to remember for both patients and providers. Text reminders to patients could enhance LCS adherence among those with prior history of LCS. Provider notification of patient eligibility is recommended regardless of patients’ prior LCS awareness or receipt. Further studies are needed to explore the effectiveness of PCP reminders in increasing LCS uptake.