Neil Jordan M, Mercaldo Nathaniel D, Tiersma Keenae, Nelson Zoe, Lee Amy, Ballini Lauren, Mao Bingjing, Shao Ruosi, Irwin Kelly, Carlos Ruth C, Park Elyse R, Flores Efrén J
Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, Oklahoma; Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Brigham Hospital, Boston, Massachusetts; Chair, Communication and Promotion Workgroup, Oklahoma Lung Cancer Roundtable.
Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
J Am Coll Radiol. 2025 Sep;22(9):1008-1018. doi: 10.1016/j.jacr.2025.06.014. Epub 2025 Jun 10.
Individuals from low-socioeconomic status (SES) communities experience worse lung cancer outcomes and multilevel barriers to lung cancer screening (LCS). Digital interventions may bridge LCS barriers. In this study, a three-phase design was used to rigorously develop, evaluate, and disseminate a digital outreach intervention to promote LCS among individuals from low-SES communities.
In phase 1, focus groups were conducted with primary care providers (n = 12), patient advocates (n = 8), and patients who had (n = 7) and had not undergone LCS (n = 8). Focus groups explored barriers and facilitators to LCS and guided the development of three LCS outreach videos, which differed by message source (radiologist, patient, or both). In phase 2, LCS-eligible individuals from a national sample (n = 315) were randomized 1:1:1 to evaluate the videos. Logistic regression analyses were conducted to quantify the association between outreach video and intent to talk to a provider about LCS. In phase 3, 636 participants due for LCS with Medicaid received the outreach video via patient portal or text or email. Reach of the intervention and 12-month LCS follow-up rates were measured.
In phase 1, participants cited fear of lung cancer and confusion about LCS eligibility criteria. In phase 2, there were no significant differences in intent to speak to a provider about LCS by outreach video type. In phase 3, a significantly greater proportion of participants reached by the intervention had scheduled or completed LCS than those not reached (32.4% vs 23.2%, P = .041).
Participants who were reached by the digital outreach intervention codeveloped and disseminated to patients from low-SES communities were more likely to complete LCS.
来自社会经济地位（SES）较低社区的个体肺癌治疗效果较差，且在肺癌筛查（LCS）方面面临多层次障碍。数字干预措施可能有助于消除LCS障碍。在本研究中，采用三阶段设计，严格开发、评估并推广一种数字外展干预措施，以促进SES较低社区个体的LCS。
在第1阶段，对初级保健提供者（n = 12）、患者权益倡导者（n = 8）以及已接受（n = 7）和未接受LCS（n = 8）的患者进行了焦点小组访谈。焦点小组探讨了LCS的障碍和促进因素，并指导制作了三段LCS外展视频，这些视频的信息来源有所不同（放射科医生、患者或两者皆有）。在第2阶段，将来自全国样本的符合LCS条件的个体（n = 315）按1:1:1随机分组，以评估这些视频。进行逻辑回归分析，以量化外展视频与与提供者谈论LCS的意愿之间的关联。在第3阶段，636名符合LCS条件且参加医疗补助计划的参与者通过患者门户、短信或电子邮件收到了外展视频。测量了干预措施的覆盖范围以及12个月的LCS随访率。
在第1阶段，参与者提到了对肺癌的恐惧以及对LCS资格标准的困惑。在第2阶段，按外展视频类型划分，与提供者谈论LCS的意愿没有显著差异。在第3阶段，与未收到干预措施的参与者相比，收到干预措施的参与者中安排或完成LCS的比例显著更高（32.4%对23.2%，P = .041）。
通过数字外展干预措施接触到的、共同开发并传播给SES较低社区患者的参与者更有可能完成LCS。
