Increasing Lung Cancer Screening Uptake Among High-Risk Emergency Department Patients

About This Grant

PROJECT SUMMARY/ABSTRACT Lung cancer is the leading cause of cancer death in the US. Although lung cancer screening (LCS), using low- dose CT scan, decreases lung cancer mortality through early disease identification, fewer than 1 in 6 eligible individuals get screened, with significant differences based on demographic and socio-economic factors. LCS is a process, not just a test. The critical first steps in this process are (1) identification of high-risk individuals who are eligible for LCS, and (2) recruitment of these individuals into an LCS program. The Emergency Department (ED) setting is optimal for an intervention to promote LCS by accomplishing these steps. Individuals at high risk for lung cancer are over-represented in the ED population, including: individuals that smoke, non-White individuals, patients with lower education levels, and the under-insured. In fact, over 2.3 million high-risk people pass through EDs every year who are eligible for LCS but have never been screened. The investigators’ long-term goal is to develop a low-cost, scalable intervention that increases LCS uptake among ED patients and is deployable in any ED with a regionally referrable LCS program. The objective of the proposed randomized clinical trial is to test the efficacies of text messaging and a facilitated referral strategy to promote uptake of LCS in order to achieve this goal. Step 1 of the approach is to identify participants that are eligible for LCS. Step 2 is to randomize eligible participants, using a 2x2 design, among four study arms: (1) basic referral for LCS (i.e. verbal referral with written materials; comprising an enhanced control arm), (2) basic referral plus a subsequent series of text messages, grounded in behavioral change theory, aimed at generating intention and motivation to get screened, (3) facilitated referral for LCS (i.e. submission of a requisition to LCS program by staff), and (4) facilitated referral plus text messages. The investigators’ pilot work demonstrated the feasibility and efficacy of the proposed approach. A total of 1036 individuals eligible for LCS will be recruited from a high-volume urban ED and a low-volume rural ED, randomized among study arms, and followed-up at 120 days to assess interval LCS uptake. The Specific Aims of the proposed project are, (1) Compare LCS program uptake among study arms that receive text messages to study arms that do not, (2) Compare LCS program uptake among study arms with basic referral to study arms with facilitated referral, (3) Investigate the interaction between receipt of text messages (yes/no) and referral type (basic/facilitated), and (4) Evaluate participant feedback on (a) differential barriers to LCS across sub-groups and (b) acceptability and appropriateness of ED-based promotion of LCS. The study team is at the forefront of developing ED-based interventions to promote cancer screening. This project leverages the universal access setting of the ED to identify individuals at greatest risk for lung cancer and get them screened. A scalable ED-based intervention that increases LCS uptake would save lives.