Lung cancer screening orders in eligible patients higher with digital health program
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Key takeaways:
- The mPATH-Lung digital health program positively impacted chest CT completion and lung cancer screening orders vs. enhanced usual care.
- Nearly 25% of the mPATH-Lung group completed CT scans.
BOSTON — Completing a CT scan and ordering lung cancer screening occurred more frequently if eligible patients received a digital health program intervention vs. enhanced usual care, according to data presented at the CHEST Annual Meeting.
“The current approach to lung cancer screening relies on very busy clinicians to pause and consider if their patient might be eligible for screening,” David P. Miller Jr., MD, MS, professor of implementation science and internal medicine and director of the Clinical and Translational Science Institute KL2 program at Wake Forest University School of Medicine, told Healio. “Then they need to take a detailed smoking history to determine if the patient qualifies, explain why screening may be helpful and talk about the potential downsides of screening like false positive results. This is incredibly difficulty to do in short visits with many competing priorities.
“We found that our direct-to-patient digital health program can offload this task from busy clinicians and increase screening rates,” Miller said.
In this multisite pragmatic randomized controlled trial, Miller and colleagues evaluated 1,333 current/former smokers (mean age, 60.7 years; 65% women; 79% non-Hispanic white) aged between 50 and 77 years to find out if the mPATH-Lung automated digital health program positively impacts chest CT scan completion and lung cancer screening orders.
Every individual met screening eligibility criteria, which researchers found out through patient online responses regarding their medical and social history via a hyperlink sent to their patient portal or phone number.
The total cohort was divided into two groups: mPATH-Lung intervention (n = 669; 64% women; 80% white) or enhanced usual care (n = 664; 66% women; 78% white). More information was given to the mPATH-Lung group (“animated lung cancer screening educational video, personalized risk/benefit information and a values clarification exercise” plus could request screening at the end) vs. the enhanced usual care group (told about screening qualification and watched video on exercise for lung health), according to researchers.
“We developed mPATH to give patients more digital self-service and offload routine tasks from busy clinicians,” Miller told Healio. “But I want to make it clear that we never envision mPATH replacing clinicians or other staff like patient navigators. Rather, we want to help them work more efficiently.
“Most patients will use mPATH and know exactly what they want,” Miller said. “But some will still have questions. mPATH lets clinicians focus their time on those with specific questions or concerns.”
Notable characteristics of the entire study population outlined in the abstract included medium/high socioeconomic status (69%), commercial insurance (47%) and public insurance (45%).
During a check in at week 16 since group assignment, 25% of those receiving the mPATH-Lung intervention completed a chest CT, which was higher than the 17% of those receiving enhanced usual care (OR = 1.6; 95% CI, 1.2-2.1).
The proportion of individuals who ordered lung cancer screening was also greater in the mPATH-Lung group (29.6%) vs. the enhanced usual care group (18.8%; OR = 1.8; 95% CI, 1.4-2.3), according to the presentation.
Within subgroups of race/ethnicity, socioeconomic status and rural/urban status, Miller noted that screening rose with mPATH-Lung and was comparable across the groups.
“Multiple prior studies have shown that Black individuals are less likely to be screened for lung cancer compared to white individuals, and they are more likely to die from lung cancer,” Miller told Healio. “Our hope was that mPATH would work equally well among all individuals to address these inequities.
“We were excited to see that mPATH increased screening twice as much in Black individuals compared to others [non-white, 12% vs. white, 6%], although it is important to note this wasn’t statistically significant,” Miller added. “Still, it is a strong sign that well-designed programs like mPATH could help improve health equity.”
Moving forward, Miller plans to continue to work on mPATH and its outreach.
“Our study demonstrates that mPATH works very well for increasing lung cancer screening,” Miller told Healio. “Our next step will be to investigate ways to get even more patients to use it.
“Although this study is over, other health systems have been using mPATH,” Miller continued. “Based on what we learned, we have adjusted mPATH’s outreach messaging and program flow, and we are seeing significantly higher use. Our goal is to ensure that everyone who qualifies for lung screening is well informed, understands their options and can access screening.”
For more information:
David P. Miller Jr., MD, MS, can be reached at dmiller@wakehealth.edu.