A Personalized Digital Outreach Intervention for Lung Cancer Screening

使用年度胸部CT来筛查肺癌，肺癌是美国癌症死亡的主要原因，可以 将死亡率降低高达20%；然而，只有不到4%的符合条件的美国人接受了筛查。美国的预防性 服务工作组支持对目前和以前的高危吸烟者进行肺癌筛查。在 与此同时，LCS会带来重大风险，如假阳性和侵入性操作。因此， 指南建议，联邦医疗保险要求患者在就诊前进行共同的决策 放映。不幸的是，初级保健提供者很少讨论LC，因此患者很少接受LC。 患者、提供者和系统障碍是导致低LCS比率的原因。许多患者并不知道LCS的存在， 它是有效的，或者他们有资格进行筛查。LCS的风险和收益在很大程度上取决于 患者的危险因素使腰腿综合征的一般教育变得困难。医疗保健提供者很穷 了解筛选标准，缺乏分享所需的时间和个性化信息 决策讨论。LCS的决策辅助是部分解决方案；它们可以增加患者 感知，提供个性化信息，并帮助患者做出筛查决定。然而，他们失败了 以解决许多提供商和系统障碍。我们的团队开发了一种创新的数字外展战略 基于社会生态理论的移动患者健康-肺技术 综合行为模式。MPATH-LONG具有多层次的功能：它(A)查询电子健康 记录以识别潜在的筛选候选人，(B)向这些个人发送访问a的电子邀请 基于网络的LCS决策辅助工具，帮助他们做出符合其价值观的筛选决策，以及(C) 使患者能够以电子方式请求LCS诊所预约，以实现强制共享决定 进行检查和随后的筛选。电子计划摘要被发送给患者和提供者，确保 与知情的参与者进行共同的决策访问。该项目将决定 在一项实用的随机对照试验中，mPATH-肺对患者决策和接受LC的影响 混合方法设计。该提案的具体目的是：1)确定mPATH-LUNG对 一项对两个大健康人群的1318名初级保健患者进行的务实随机对照试验中LCS的接收 覆盖范围延伸至5个州的网络；2)阐明患者LCS决定的驱动因素和 使用价值澄清练习和对至少60名患者的半结构化访谈来筛选行为 被选为代表决策-行为一致性的光谱；以及3)探索实施 结果将影响mPATH肺的可持续性和传播，使用方案数据，调查， 和采访。该项目可以通过扩大LC的使用来降低肺癌的发病率和死亡率 同时支持以患者为中心的护理。重要的是，我们的数字外展设计可以 对其他健康状况的广泛适用性，将这一提议的影响扩大到LCS以外。

Using annual chest CTs to screen for lung cancer, the leading cause of cancer death in the United States, can reduce mortality by up to 20%; however, fewer than 4% of eligible Americans are screened. The US Preventive Services Task Force endorses lung cancer screening (LCS) for high risk current and former smokers. At the same time, LCS poses significant risks, such as false positives and invasive procedures. Accordingly, guidelines recommend and Medicare requires that patients engage in a shared decision making visit prior to screening. Unfortunately, primary care providers rarely discuss, and consequently patients rarely receive, LCS. Patient, provider, and system barriers contribute to low LCS rates. Many patients are unaware that LCS exists, that it is effective, or that they qualify for screening. The risks and benefits of LCS vary substantially according to patients’ risk factors making general education about LCS difficult. Healthcare providers have poor understanding of the screening criteria and lack the time and personalized information needed for shared decision making discussions. Decision aids for LCS are a partial solution; they can increase patient awareness, deliver personalized information, and help patients make a screening decision. However, they fail to address many provider and system barriers. Our team has developed an innovative digital outreach strategy called mPATH-Lung (mobile Patient Technology for Health – Lung) based on Social Ecological Theory and the Integrative Model of Behavior. mPATH-Lung has multilevel functionality: it (a) queries the electronic health record to identify potential screening candidates, (b) sends those individuals electronic invitations to visit a web-based LCS decision aid that helps them make a screening decision concordant with their values, and (c) empowers patients to electronically request an LCS clinic appointment for the mandated shared decision making and subsequent screening. Electronic program summaries are sent to patients and providers, ensuring shared decision making visits occur with informed participants. This project will determine the impact of mPATH-Lung on patient decision making and receipt of LCS in a pragmatic randomized controlled trial using a mixed methods design. The Specific Aims of the proposal are to: 1) Determine the effect of mPATH-Lung on receipt of LCS in a pragmatic randomized-controlled trial of 1318 primary care patients in two large health networks with a catchment area extending to 5 states; 2) Elucidate the drivers of patients’ LCS decisions and screening behavior using a values clarification exercise and semi-structured interviews with at least 60 patients selected to represent the spectrum of decision-behavior concordance; and 3) Explore implementation outcomes that will impact the sustainability and dissemination of mPATH-Lung using program data, surveys, and interviews. This project could decrease lung cancer morbidity and mortality by broadening the use of LCS while simultaneously supporting patient-centered care. Importantly, our digital outreach design could have broad applicability to other health conditions, expanding the impact of this proposal beyond LCS.