A Multilevel Approach to Improve Participation in Low-Dose CT for Lung Cancer Screening (Empower LCS): A Single-Arm Pilot Feasibility Clinical Trial

Purpose: To evaluate the preliminary efficacy of a multilevel intervention, informed by the Health Belief Model, in improving lung cancer screening (LCS) uptake among a diverse population by addressing both patient- and provider-level barriers.

Methods/Materials: Eligible patients were aged 50–80, English-, Spanish-, or Vietnamese- speaking, and met the 2021 USPSTF LCS criteria (≥20 pack-years smoking history and currently smoking or quit within the past 15 years). Patients were identified through an institutional data warehouse and multilingual community outreach. Participants completed a baseline survey assessing knowledge, perceived severity, barriers, and self-efficacy related to LCS. Participants received the Empower LCS intervention, which included: (1) a decision aid detailing LCS risks and benefits (2) a text reminder encouraging LCS discussion with their primary care provider (PCP)(3) PCP electronic health record (EMR) notifications regarding patients’ LCS eligibility and barriers to receipt of LCS and (4) referrals to financial navigation services for those screening positive for health-related social needs (HRSNs). A follow-up survey at 6 months assessed changes in health beliefs, LCS discussions, orders, and completion, supplemented by an EMR review. The primary endpoint was LCS completion at 6 months post-enrollment.

Results: In total, 70 patients enrolled (mean age: 62.5 ± 6.3; 70% male; 1.4% Black, 18.6% Asian, 44.3% White, 35.7% Other). 45.7% were Hispanic, and 41% were current smokers. Common LCS barriers included concerns about cost (40%, 28/70), and fear of finding something wrong (34.3%, 24/70). At 6 months, 71.4% (50/70) discussed LCS with their PCP, 51.4% (36/70) received LDCT orders, and 27.1% (19/70) completed screening. Knowledge and perceived severity changed significantly (knowledge: 1.91 to 2.67, p = 0.01; severity: 16.3 to 18.1, p=0.0003). No significant changes were observed in perceived barriers or self-efficacy scores.

Conclusions: The Empower LCS intervention improved LCS discussion and orders, but completion remained low, though exceeding the national average of 16%, underscoring the need for enhanced patient navigation and follow-up support.