R01CA262015

Multilevel Interventions to Increase Adherence to Lung Cancer Screening - Abstract

Screening for lung cancer has the potential for a profound public health benefit. Lung cancer is the leading cause of US cancer morbidity and mortality for both men and women, responsible for more deaths than breast, cervical, colorectal, and prostate cancers combined. Annual screening with low-dose computed tomography (LDCT) reduced lung cancer mortality by 20%. Successful population-based screening requires continuous monitoring to adhere to repeat screening in high-risk adults to achieve similar results. Repeat annual screening is necessary for the early detection of lung cancer. Baseline or first LDCT scans detect prevalent lung cancer, while subsequent screening detects new nodules. However, adherence to screening is low, ranging at 28-38% from centers nationally.

Multilevel interventions, which target patients, clinicians, and healthcare systems, offer a promising framework to address the gaps in lung cancer screening to achieve guideline-recommended lung cancer screening. Our mixed-methods pilot study with KPWA stakeholders identified two critical components to improve adherence to repeat screening: providing education for patients on lung cancer screening and offering reminders for on-time return to screening. We developed two novel patient-centered interventions using principles of human-centered design to address these needs:

1) Patient Voices Video that incorporates patient testimonials to acknowledge receipt of screening, a tailored reminder of time due for the next scan, and reassurance to reduce fear of screening and the role of loved ones to support health choices.

2) Stepped Reminders, which directly remind patients when their next scan is due.

Both interventions are facilitated by a health system electronic health record (EHR) build to track patients for population health management and a clinically-embedded medical assistant to deliver interventions.

The goal of this proposal is to test these two interventions relative to usual care to promote adherence to repeat screening in a pragmatic cluster randomized trial enrolling 1775 adult KPWA members who complete a screening LDCT in 2022-2025 across 34 KPWA primary care clinics in a 2x2 factorial-designed study. Study arms include:

A) Stepped reminders alone
B) Patient Voices Video alone
C) Both interventions
D) Usual care

To address our goals, our specific aims are to:

1) Compare the effectiveness of two multilevel interventions relative to usual care in improving:
a) Rates of adherence to lung cancer screening
b) Patient-centered outcomes
c) Clinic outcomes

2) Determine the patient-, clinician-, and system-level factors that influence changes in adherence to inform lung cancer screening programs.

To date, no randomized clinical trial has evaluated strategies to improve adherence to lung cancer screening in US populations with multilevel strategies. We will move the field forward by providing effective, scalable interventions to improve lung cancer screening adherence to achieve the population-based mortality benefits promised by large clinical trials that motivated screening guidelines.

Kaiser Foundation Hospitals

TO IDENTIFY CANCER RISKS AND RISK REDUCTION STRATEGIES, TO IDENTIFY FACTORS THAT CAUSE CANCER IN HUMANS, AND TO DISCOVER AND DEVELOP MECHANISMS FOR CANCER PREVENTION AND PREVENTIVE INTERVENTIONS IN HUMANS. RESEARCH PROGRAMS INCLUDE: (1) CHEMICAL, PHYSICAL AND MOLECULAR CARCINOGENESIS, (2) SCREENING, EARLY DETECTION AND RISK ASSESSMENT, INCLUDING BIOMARKER DISCOVERY, DEVELOPMENT AND VALIDATION, (3) EPIDEMIOLOGY, (4) NUTRITION AND BIOACTIVE FOOD COMPONENTS, (5) IMMUNOLOGY AND VACCINES, (6) FIELD STUDIES AND STATISTICS, (7) CANCER CHEMOPREVENTION AND INTERCEPTION, (8) PRE-CLINICAL AND CLINICAL AGENT DEVELOPMENT, (9) ORGAN SITE STUDIES AND CLINICAL TRIALS, (10) HEALTH-RELATED QUALITY OF LIFE AND PATIENT-CENTERED OUTCOMES, AND (11) SUPPORTIVE CARE AND MANAGEMENT OF SYMPTOMS AND TOXICITIES. SMALL BUSINESS INNOVATION RESEARCH (SBIR) PROGRAM: TO EXPAND AND IMPROVE THE SBIR PROGRAM, TO STIMULATE TECHNICAL INNOVATION, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT FUNDING, TO INCREASE SMALL BUSINESS PARTICIPATION IN FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION IN INNOVATION AND ENTREPRENEURSHIP BY WOMEN AND SOCIALLY/ECONOMICALLY DISADVANTAGED PERSONS. SMALL BUSINESS TECHNOLOGY TRANSFER (STTR) PROGRAM: TO STIMULATE AND FOSTER SCIENTIFIC AND TECHNOLOGICAL INNOVATION THROUGH COOPERATIVE RESEARCH AND DEVELOPMENT CARRIED OUT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO FOSTER TECHNOLOGY TRANSFER THROUGH COOPERATIVE RESEARCH AND DEVELOPMENT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT FUNDING, AND FOSTER PARTICIPATION IN INNOVATION AND ENTREPRENEURSHIP BY WOMEN AND SOCIALLY/ECONOMICALLY DISADVANTAGED PERSONS.

93.393 - Cancer Cause and Prevention Research

National Cancer Institute (NCI) [HHS - NIH]

Seattle, Washington 981011466 United States

Single Zip Code

Cancer Prevention and Control Clinical Trials Grant Program (R01 Clinical Trial Required) (PAR-18-559)

Amendment Since initial award the total obligations have increased 369% from $712,200 to $3,340,674.