Multilevel Interventions to Increase Adherence to Lung Cancer Screening (Larch)

Screening for lung cancer has the potential for a profound public health benefit. Repeat annual screening is necessary for early detection of lung cancer. The investigators will test two interventions which include patient education and reminders to improve adherence to lung cancer screening.

Screening for lung cancer has the potential for a profound public health benefit. Successful population-based screening requires continuous monitoring to adherence repeat screening in high risk adults to achieve similar results. Repeat annual screening is necessary for early detection of lung cancer. Baseline or first LDCT scans detect prevalent lung cancer, when subsequent screening detects new nodules. However, adherence to screening is low, ranging at 28-38% from centers nationally. The investigators developed two novel, patient-centered interventions to address patient education and offering reminders for on-time screening. To address these goals, the specific aims are to: 1) Compare effectiveness of two multilevel interventions relative to usual care in improving (a) rates of adherence to lung cancer screening, (b) patient-centered outcomes; and (c) clinic outcomes; and 2) Determine the patient-, clinician-, and system-level factors that influence changes in adherence to inform lung cancer screening programs.

Lung Cancer, Low dose CT (LDCT), Lung Cancer Screening, Stepped Reminders, Educational Video, User centered design, Stakeholders, Evaluation, Qualitative, Patient Partners, Adherence

About 3 weeks after the index LDCT, the study Medical Assistant (MA) will deliver a link to the Patient Voices Video, an educational video about lung cancer screening.

Prior to patient's next LDCT scan is due, MA begins Stepped Reminders intervention: MA pends LDCT orders to PCP to sign. MA sends reminders to patient when order is placed and follows up by phone if patient has not scheduled LDCT.

See above. Those assigned to the Patient Video and Stepped Reminders will receive both interventions, as described above.

Stepped Reminders, which directly reminds providers to order the next LDCT scan and then reminds patients they are due and prompts them to schedule LDCT with Radiology.

Knowledge of lung cancer screening eligibility, time to return and cost on patient reported outcomes survey.

The Lung Cancer Screening Health Belief Scales: 1) perceived risk of lung cancer (3 items); 2) perceived benefits of lung cancer screening (6 items); (3) perceived barriers to lung cancer screening (17 items); and (4) self-efficacy for lung cancer screening (9 items).

Inclusion Criteria: KPWA members Aged 50-78 years Have a negative screening LDCT scan Speak English or Spanish Meet US Preventive Services Task Force guidelines Exclusion Criteria: Patients who were previously diagnosed with lung cancer, Patients who have a positive scan, Patients who have an indicator for interpreter services, except for Spanish