Automated Digital Health Program May Help Overcome Lung Cancer Screening Barriers

An automated digital health program “could overcome many system-level barriers” to lung cancer screening and increase screening rates, according to research presented at the CHEST Annual Meeting 2024 in Boston, Massachusetts.

David Miller, MS, MD, and colleagues developed an automated digital health program called mPATH-Lung that identifies people eligible for lung cancer screening, educates them about their options, and allows them to request lung cancer screening directly via the program. It was important to develop and evaluate the program because “despite years of public campaigns, lung cancer screening rates in the United States remain below 20%,” the researchers explained.

To assess how the digital health program affected lung cancer screening rates, Dr. Miller and colleagues conducted a multisite pragmatic randomized controlled trial of mPATH-Lung. The researchers queried electronic health record systems each week at 2 large academic health systems to identify people who currently or formerly smoked, were aged 50-76 years, did not have any significant comorbidities, and had primary care visits scheduled in the next 2 weeks.

Those identified received patient portal or mobile text messages to inform them of lung cancer screening availability. The recipients of these messages were invited to click a hyperlink that took them to a web-based program that asked medical and social history questions to determine if lung cancer screening is recommended for them.

The researchers identified patients who met lung cancer screening eligibility criteria, and they were automatically randomized to receive enhanced usual care of the mPATH-Lung intervention. The enhanced usual care consisted of advising patients that they qualified for lung cancer screening and showing them a video about exercise for lung health. The mPATH-Lung intervention included an animated video about lung cancer screening, personalized information about risks and benefits, and a values clarification exercise. The mPATH-lung intervention concludes by asking patients if they want to receive lung cancer screening and allows them to request lung cancer screening without requiring a primary care visit.

The study’s primary outcome was the completion of a chest computed tomography (CT) scan within 16 weeks of randomization. The secondary outcomes included orders for lung cancer screenings. Over the course of 13 months (April 2022-May 2023), the study investigators randomized 1,333 patients with a mean age of 60.7 years to receive enhanced usual care or the mPATH-Lung intervention. Most patients identified as non-Hispanic white (79%) and 65% were female (65%). Most patients had medium to high socioeconomic status (69%), with 47% having commercial insurance and 45% having public insurance.

The study showed that 24.5% of patients who were randomized to receive the mPATH-Lung intervention completed a CT within 16 weeks, compared to 17% of those receiving enhanced usual care (odds ratio [OR], 1.6).

In addition, 29.6% of patients receiving the mPATH-Lung intervention had lung cancer screening ordered, compared to 18.8% of those receiving enhanced usual care (OR, 1.8). When Dr. Miller and colleagues conducted subgroup analyses, they “observed similar increases in screening” by race/ethnicity, age, sex, socioeconomic status, and insurance type.

“The mPATH-Lung direct-to-patient digital health program significantly increased the proportion of patients who had [lung cancer screening] ordered and a CT completed, with similar effects by patient demographics,” Dr. Miller and colleagues explained. “Future studies should investigate strategies for implementing digital health interventions in routine care.”

The researchers also reflected on the clinical implications of the research, emphasizing that “by offloading screening tasks from busy clinicians and giving patients access to digital self-service, digital health interventions could overcome many system-level barriers to [lung cancer screening] and increase screening rates.”

Reference

A direct-to-patient digital health program increases lung cancer screening: a pragmatic randomized controlled trial of mPATH-lung | CHEST Annual Meeting 2024