Integrating Telehealth to Advance Lung Cancer Screening
Abramson Cancer Center at Penn Medicine
Summary
The goal of this pragmatic trial is to learn if telehealth strategies can increase shared decision-making (SDM) for lung cancer screening (LCS). It will also learn about the equity of these strategies by conducting non-inferiority analysis by race and sex. The main questions it aims to answer are: 1. Does patient outreach using synchronous and asynchronous telehealth strategies increase completion of SDM visits for LCS? 2. Is the effectiveness of these telehealth strategies similar by race and sex? The study uses a Sequential Multiple Assignment Randomized Trial (SMART) design and includes two stages of interventions. The first stage of intervention includes direct patient outreach with an invitation to schedule either a 1) telehealth SDM visit or 2) telehealth or in-person SDM visit. Participants that do not respond to the first stage interventions receive a text message reminder encouraging SDM visit completion with or without digital care coordination.
Description
Annual lung cancer screening using low-dose computed tomography (LDCT) is associated with decreased lung cancer mortality but also with harms. As such, it is recommended, and required for reimbursement, that patients complete an shared decision-making visit (SDM) prior to screening to discuss potential risks and benefits in the context of patient values. Despite guidelines recommending screening and national insurance coverage of LDCT, uptake of SDM visits and subsequent LDCT is remarkably low. We aim to address these gaps by comparing the effectiveness of synchronous and asynchronous teleheal…
Eligibility
- Age range
- 50–80 years
- Sex
- All
- Healthy volunteers
- No
Inclusion criteria: Participants will be eligible if: 1. are aged 50 to 80 2. have a history of tobacco use indicated by either: Documented 20 pack-year or greater smoking history in their electronic health record (EHR); OR Self-report via structured survey 3. currently smoke or formerly smoked cigarettes 4. have no documented history of lung cancer 5. have no documented history of lung cancer screening in the 24 months prior to study enrollment 6. have completed at least one primary care visit at Penn Medicine in the 3 years prior to study enrollment. Exclusion criteria: Participants who…
Interventions
- BehavioralActive Choice
The participant will be send a letter inviting them to complete a SDM visit either in-person or via telehealth.
- BehavioralTelehealth Only
The participant will be send a letter inviting them to complete a SDM visit via telehealth only.
- BehavioralLow Touch Strategy
Patient will be sent asynchronous text messaging reminders encouraging SDM for LCS using framed messaging.
- BehavioralHigh Touch Strategy
Patient will be sent asynchronous text messaging reminders encouraging SDM for LCS using framed messaging in combination with synchronous telephone-based digital care coordination.
Location
- University of PennsylvaniaPhiladelphia, Pennsylvania