Digital Health Program Improves Lung Cancer Screening Uptake

A digital health intervention that delivers information directly to patients outside clinical visits could improve lung cancer screening rates compared with enhanced usual care, trial findings suggest.

The mPATH-Lung digital intervention showed an impact across demographic and socioeconomic groups and could help overcome barriers to access among underserved populations.

The findings, in JAMA, also highlight how integrating digital tools into healthcare can enable patient portals and text messaging to deliver outreach programs directly to patients in a way that may improve the uptake of preventive care.

In an editorial accompanying the findings, Lauren Kearney, MD, from Boston University Medical Center, and colleagues acknowledge the promise of the digital intervention but noted the complexity of the lung cancer screening pathway.

“Although the intervention increased screening rates to nearly one-quarter of eligible individuals, this remains well below uptake levels achieved for other cancer screenings,” they pointed out.

“Moreover, the intervention’s overall reach was modest—only 12% of those invited completed the eligibility assessment, highlighting the need for more expansive and inclusive approaches to promote equitable access to lung cancer screening.”

Lung cancer is the leading cause of cancer death worldwide and early detection improves survival rates. Yet its uptake is persistently low, with less than a fifth of eligible U.S. adults receiving recommended computed tomography (CT) screening.

Direct-to-patient interventions may be one way to overcome key barriers, reaching people outside traditional clinical encounters and increasing awareness of lung cancer screening.

By providing accessible information on the availability of screening, eligibility, and the potential benefits and harms of screening, these interventions can empower patients to engage in discussions with clinicians and support informed decision-making.

To investigate further, David Miller, MD, from Wake Forest University School of Medicine in Winston-Salem, North Carolina, and colleagues conducted a pragmatic trial, which aimed to emulate a real-world setting, among 1333 English-speaking adults at two U.S. academic health systems.

All participants were eligible for lung cancer screening based on Medicare and Medicaid criteria, aged 50-77 years, current or former smokers, with a primary care visit, with a primary care visit scheduled for the near future. Approximately two-thirds were women.

In terms of race and ethnicity, 17% Black and 79% non-Hispanic White, with others making up around one percent each per group.

Participants were randomly assigned to either the automated mPATH-Lung digital care intervention or enhanced usual care.

mPATH-Lung was delivered via a patient portal or text messages and included a brief decision aid video explaining the benefits and harms of screening, a values clarification exercise, and an optional personalized risk-benefit assessment tool. Participants who were interested in pursuing screening could request a screening appointment.

Under enhanced usual care, participants were informed of their eligibility for screening, shown a five-minute video about exercise for lung health, and encouraged to discuss screening with their primary care clinician.

The primary outcome of completing a chest CT completion at 16 weeks after randomization was significantly greater among the 669 participants assigned to mPATH-Lung than the 664 assigned to enhanced usual care, at 24.5% versus 17.0%, respectively (odds ratio [OR]=1.6).

Results were similar when the outcome was narrowed specifically to completion of a low-dose lung cancer screening chest CT, at a corresponding 22.4% versus 14.3% (OR=1.7).

Several secondary outcomes were also assessed. False-positive CT results were more common with the digital intervention than enhanced usual care, at a corresponding 12.7% versus 8.4%.

A greater proportion of patients receiving the digital intervention had a lung cancer screening CT ordered compared with the control group, at 29.6% versus 18.8% (OR=1.8). But among those with an order, scan completion rates were the same in both groups at 76%.

The researchers concluded: “Further research is needed to assess the reach and effectiveness of digital health interventions for lung cancer screening across diverse populations and healthcare settings.”