Optimizing adherence to lung cancer screening: Applying theory and implementation science to participant engagement

Hackensack University Medical Center, Hackensack NJ

Investigators

Linked publications & trials

Abstract

Lung cancer is the leading cause of cancer death in the US, with most lung cancer diagnosed at advanced stages. Low-dose CT screening of high-risk individuals is the only evidence-based tool available to diagnose lung cancer at an early stage when curable treatment options exist. The promising mortality reduction benefit of lung cancer screening (LCS) is presently overwhelmingly unfulfilled due to suboptimal population-based adherence to annual screening guidelines. Outside of research settings, adherence to annual LCS is less than half of the rates observed in the practice-changing, landmark clinical trials. There is an urgent need for effective and feasible interventions to improve LCS adherence and achieve optimal individual and population health benefits. There is an unmet need for development and implementation of low-burden interventions aimed at improving adherence to annual LCS that can readily be implemented into busy clinical settings. Pragmatic study design and implementation science strive to close the gap between clinical research and practice by engaging health care systems, clinicians, and patients into the research process to understand the context of the clinical setting and successfully implement scalable interventions that meet the needs and desired outcomes. Work completed during the F99 phase took a first step to address this need by creating a set of reminder messages specific for LCS annual adherence, developed using the Cognitive-Social Health Information Processing Model and principles of user-centered design to directly encompass information about LCS-eligible individuals into the design and testing of the intervention. During the K00 phase, focus will shift to honing skills in pragmatic study design and implementation science to build expertise in developing trustworthy stakeholder relationships and evaluation of local clinical environment. These skills will lead to implementation of interventions that are acceptable, feasible, and sustainable in real-world settings. Aim 1 will use triangulation of survey and interview from a nationally representative sample of LCS programs to pinpoint clinic or system challenges and facilitator combinations that influence annual adherence. In Aim 2, content and imagery combinations of the reminder message intervention will be further refined with screen-eligible populations. Aim 3 will focus on conducting preliminary acceptability and feasibility testing with community LCS programs. Upon completion of these aims I will possess the necessary skills and knowledge needed to become independent and will be poised to lead a type 1 hybrid effectiveness-implementation trial for concurrent assessment of effectiveness and implementation outcomes of the reminder message system in real-world community LCS programs On a broader scale, this evaluative work will also pave the way to quickly implement and disseminate more interventions to improve LCS adherence (i.e., provider education, small media), ultimately maximizing the number of early lung cancers diagnosed and optimizing the individual and population health benefits of LCS.