Increasing Equitable Adherence to Annual Lung Cancer Screening and Diagnostic Follow-up

  • Behavior Change,
  • Clinical Transformation
Project Status: Complete

This project tests the effects of combinations of patient- and clinician-directed nudges. Using patient-directed messaging and electronic health record (EHR) prompts, this project aimed to increase early detection of lung cancer by removing individual and system-level barriers to identifying and prompting patients who are due for care.

Lung cancer screening (LCS) using low-dose computed tomography (LDCT) can help reduce lung cancer mortality, but it requires annual screening and timely follow-up to be most effective. Despite national guidelines recommending annual screening and insurance coverage of LDCT for eligible patients, uptake and follow-up adherence remain low. Factoring in racial, geographical, and socioeconomic disparities and a 2021 update to LCS guidelines that expanded the eligible population by more than 6 million people, the need for equitable, effective, and sustainable solutions to increase adherence to annual LCS and follow-up is urgent.

To develop sustainable approaches for improving annual LCS adherence and follow-up across all patients, PC3I Director Katharine Rendle, PhD, MSW, MPH and PC3I Faculty Anil Vachani, MD, MS led a study to test the effects of combinations of both patient- and clinician-directed nudges. Using patient-directed messaging and electronic health record (EHR) prompts, this project aimed to increase early detection of lung cancer by removing individual and system-level barriers to identifying and prompting patients who are due for care.

This pragmatic, randomized controlled trial—conducted in a network of primary care and specialty practices affiliated with Penn Medicine—focused on testing two specific nudge strategies.

  1. Gain-framed messaging (Patient Nudge): Patients received a persuasive text message encouraging them to complete recommended follow-up of annual or diagnostic scans.
  2. EHR-based alerts (Clinician Nudge): A prompt within the electronic health record (EHR) alerted clinicians when a patient was due for screening and diagnostic follow-up. If the patient did not have an existing order, the message also included a pended order for the clinician to sign via the EHR.

After the trial period, a subset of patients and clinicians were invited to participate in a survey and interview to identify individual and system-level factors that may have affected the impact of the strategies.

This project helped support equitable implementation of strategies to increase LCS adherence and follow-up across diverse settings and populations. Preliminary results showed that the combined nudge strategy increased lung cancer screening rates more than 3-fold compared to usual care, and observed no differences in effectiveness across patient groups.

National Comprehensive Cancer Network (NCCN); AstraZeneca

Project Leads

  • Katharine Rendle

    PhD, MSW, MPH

    Director, Penn Center for Cancer Care Innovation

  • Anil Vachani

    MD, MS

    Co-Director of Lung Cancer Screening and Associate Professor of Medicine

Project Team

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