Stang Garrett S, Tanner Nichole T, Hatch Ashley, Godbolt Jakarri, Toll Benjamin A, Rojewski Alana M
Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States.
Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States.
JMIR Form Res. 2024 Jun 12;8:e53159. doi: 10.2196/53159.
Approximately 14 million individuals in the United States are eligible for lung cancer screening (LCS), but only 5.8% completed screening in 2021. Given the low uptake despite the potential great health benefit of LCS, interventions aimed at increasing uptake are warranted. The use of a patient-facing electronic health record (EHR) patient portal direct messaging tool offers a new opportunity to both engage eligible patients in preventative screening and provide a unique referral pathway for tobacco treatment.
This study sought to develop and pilot an EHR patient-facing self-referral tool for an established LCS program in an academic medical center.
Guided by constructs of the Health Belief Model associated with LCS uptake (eg, knowledge and self-efficacy), formative development of an EHR-delivered engagement message, infographic, and self-referring survey was conducted. The survey submits eligible self-reported patient information to a scheduler for the LCS program. The materials were pretested using an interviewer-administered mixed methods survey captured through venue-day-time sampling in 5 network-affiliated pulmonology clinics. Materials were then integrated into the secure patient messaging feature in the EHR system. Next, a one-group posttest quality improvement pilot test was conducted.
A total of 17 individuals presenting for lung screening shared-decision visits completed the pretest survey. More than half were newly referred for LCS (n=10, 60%), and the remaining were returning patients. When asked if they would use a self-referring tool through their EHR messaging portal, 94% (n=16) reported yes. In it, 15 participants provided oral feedback that led to refinement in the tool and infographic prior to pilot-testing. When the initial application of the tool was sent to a convenience sample of 150 random patients, 13% (n=20) opened the self-referring survey. Of the 20 who completed the pilot survey, 45% (n=9) were eligible for LCS based on self-reported smoking data. A total of 3 self-referring individuals scheduled an LCS.
Pretest and initial application data suggest this tool is a positive stimulus to trigger the decision-making process to engage in a self-referral process to LCS among eligible patients. This self-referral tool may increase the number of patients engaging in LCS and could also be used to aid in self-referral to other preventative health screenings. This tool has implications for clinical practice. Tobacco treatment clinical services or health care systems should consider using EHR messaging for LCS self-referral. This approach may be cost-effective to improve LCS engagement and uptake. Additional referral pathways could be built into this EHR tool to not only refer patients who currently smoke to LCS but also simultaneously trigger a referral to clinical tobacco treatment.
在美国，约有1400万人符合肺癌筛查（LCS）条件，但2021年只有5.8%的人完成了筛查。鉴于LCS虽有潜在的巨大健康益处但接受率较低，有必要采取旨在提高接受率的干预措施。使用面向患者的电子健康记录（EHR）患者门户直接消息工具，为促使符合条件的患者参与预防性筛查以及提供独特的烟草治疗转诊途径提供了新机会。
本研究旨在为一家学术医疗中心已有的LCS项目开发并试点一种面向EHR患者的自我转诊工具。
以与LCS接受率相关的健康信念模型构建（如知识和自我效能）为指导，对通过EHR发送的参与信息、信息图表和自我转诊调查进行了形成性开发。该调查将符合条件的自我报告患者信息提交给LCS项目的调度程序。通过在5家网络附属肺病诊所进行的场所-日期-时间抽样，使用访谈员管理的混合方法调查对材料进行了预测试。然后将材料整合到EHR系统的安全患者消息功能中。接下来，进行了一组后测质量改进试点测试。
共有17名前来进行肺部筛查共同决策就诊的患者完成了预测试调查。超过一半是新转诊进行LCS的患者（n = 10，60%），其余为复诊患者。当被问及是否会通过EHR消息门户使用自我转诊工具时，94%（n = 16）的人回答是。其中，15名参与者提供了口头反馈，促使在试点测试前对工具和信息图表进行了改进。当该工具的初始应用发送给150名随机抽取的患者的便利样本时，13%（n = 20）的人打开了自我转诊调查。在完成试点调查的20人中，45%（n = 9）根据自我报告的吸烟数据符合LCS条件。共有3名自我转诊者预约了LCS。
预测试和初始应用数据表明，该工具是一种积极的刺激因素，可触发符合条件患者进行LCS自我转诊的决策过程。这种自我转诊工具可能会增加参与LCS的患者数量，也可用于协助自我转诊到其他预防性健康筛查。该工具对临床实践有影响。烟草治疗临床服务或医疗保健系统应考虑使用EHR消息进行LCS自我转诊。这种方法可能具有成本效益，可提高LCS的参与度和接受率。可以在这个EHR工具中建立额外的转诊途径，不仅将目前吸烟的患者转诊到LCS，还能同时触发转诊到临床烟草治疗。
