Abstract
BACKGROUND: Many patients are unaware of the need to repeat lung cancer screening (LCS) annually despite shared decision-making. A health communication intervention was tested to improve patient knowledge, tobacco-related stigma, and self-efficacy in LCS. RESEARCH QUESTION: Does additional health communication improve patient knowledge of LCS timeliness? STUDY DESIGN AND METHODS: Trial participants aged 50 to 78 years with a normal LCS scan were randomized to the intervention or control arm. The intervention was delivered 3 weeks following an LCS scan. Intervention participants received health communication (print plus video) with 3 key messages to normalize routine LCS; a reminder of when due for screening; and encouraging social connection. Interventions were primarily delivered through the electronic health record patient portal. Eight weeks following the scan, all participants were invited to complete an online or telephone survey about knowledge, tobacco-related stigma, and self-efficacy. Modified Poisson and linear regression was used to test association of the intervention on secondary trial outcomes, using weights to account for survey nonresponse. Heterogeneity of the intervention effect was tested by using tobacco and LCS histories. RESULTS: The survey participation rate was 38.9% with 714 respondents (n = 363 intervention; n = 351 control). Knowledge to return in 1 year improved by 13% in the intervention arm vs the control arm (relative risk, 1.13; 95% CI, 1.05-1.22; P < .001). Intervention increased the proportion by 21.9% who knew to return in 1 year from 62.0% to 83.9% (relative risk, 1.35; 95% CI, 1.16-1.58) in first-time screeners but no difference in those screened 2 or more times. No other statistically significant differences in knowledge were detected. In the control arm, both tobacco-related stigma (mean, 13.9; 95% CI, 13.6-14.2) and self-efficacy (mean, 29.0; 95% CI, 28.6-29.4) were high and unchanged by the intervention. INTERPRETATION: A multiformat LCS intervention was shown to improve short-term knowledge of LCS timeliness to return. This finding suggests that additional health communication beyond shared decision-making might encourage repeat screening, especially in first-time screeners. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; No.: NCT05747443; URL: www. CLINICALTRIALS: gov.