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The Reach and Feasibility of an Interactive Lung Cancer Screening Decision Aid Delivered by Patient PortalFunding This study received funding from the Wake Forest University Comprehensive Cancer Center (NCI CCSG P30CA012197) and the Wake Forest Clinical and Translational Science Institute (NCATS UL1TR001420).
16 August 2018
16 November 2018
09 January 2019 (online)
Objective Health systems could adopt population-level approaches to screening by identifying potential screening candidates from the electronic health record and reaching out to them via the patient portal. However, whether patients would read or act on sent information is unknown. We examined the feasibility of this digital health outreach strategy.
Methods We conducted a single-arm pragmatic trial in a large academic health system. An electronic health record algorithm identified primary care patients who were potentially eligible for lung cancer screening (LCS). Identified patients were sent a patient portal invitation to visit a LCS interactive Web site which assessed screening eligibility and included a decision aid. The primary outcome was screening completion. Secondary outcomes included the proportion of patients who read the invitation, visited the interactive Web site, and completed the interactive Web site.
Results We sent portal invitations to 1,000 patients. Almost all patients (86%, 862/1,000) read the invitation, 404 (40%) patients visited the interactive Web site, and 349 patients (35%) completed it. Of the 99 patients who were confirmed screening eligible by the Web site, 81 made a screening decision (30% wanted screening, 44% unsure, 26% declined screening), and 22 patients had a chest computed tomography completed.
Conclusion The digital outreach strategy reached the majority of patient portal users. While the study focused on LCS, this digital outreach approach could be generalized to other health needs. Given the broad reach and potential low cost of this digital strategy, future research should investigate best practices for implementing the system.
Keywordselectronic health records - eligibility determination - decision support techniques - patient portals - cancer early detection
This work has been presented in oral poster format at the Society of General Internal Medicine National Meeting in the category of Innovations in Clinical Practice in Washington DC (April 2017). No elements of this work have been published elsewhere and the paper article is not under consideration at other journals.
Protection of Human and Animal Subjects
The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects, and was reviewed and approved by Wake Forest School of Medicine Institutional Review Board (IRB00036974). The study is on ClinicalTrials.gov (Identifier: NCT02962115; URL: https://clinicaltrials.gov/ct2/show/NCT02962115).
- 1 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016; 66 (01) 7-30
- 2 Aberle DR, Adams AM, Berg CD. , et al; National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011; 365 (05) 395-409
- 3 Smith RA, Manassaram-Baptiste D, Brooks D. , et al. Cancer screening in the United States, 2015: a review of current American cancer society guidelines and current issues in cancer screening. CA Cancer J Clin 2015; 65 (01) 30-54
- 4 Detterbeck FC, Mazzone PJ, Naidich DP, Bach PB. Screening for lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143 (5, Suppl): e78S-e92S
- 5 Moyer VA. ; U.S. Preventive Services Task Force. Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2014; 160 (05) 330-338
- 6 Lung cancer screening | Medicare.gov. Available at: https://www.medicare.gov/coverage/lung-cancer-screening.html . Accessed August 18, 2017
- 7 Centers for Medicare & Medicaid Services. “Decision memo for screening for lung cancer with low dose computed tomography (LDCT)(CAG-00439N).” 2015 [2015–03–02]. Available at: http://www.cms.gov/medicare-eoverage-data-base/details/nca-decision-memo.aspx . Accessed December 5, 2018
- 8 Kovalchik SA, Tammemagi M, Berg CD. , et al. Targeting of low-dose CT screening according to the risk of lung-cancer death. N Engl J Med 2013; 369 (03) 245-254
- 9 Pinsky PF, Bellinger CR, Miller Jr DP. False-positive screens and lung cancer risk in the National Lung Screening Trial: implications for shared decision-making. J Med Screen 2018; 25 (02) 110-112
- 10 Jemal A, Fedewa SA. Lung cancer screening with low-dose computed tomography in the United States-2010 to 2015. JAMA Oncol 2017; 3 (09) 1278-1281
- 11 Kanodra NM, Pope C, Halbert CH, Silvestri GA, Rice LJ, Tanner NT. Primary care provider and patient perspectives on lung cancer screening. A qualitative study. Ann Am Thorac Soc 2016; 13 (11) 1977-1982
- 12 Lewis JA, Petty WJ, Tooze JA. , et al. Low-dose CT lung cancer screening practices and attitudes among primary care providers at an academic medical center. Cancer Epidemiol Biomarkers Prev 2015; 24 (04) 664-670
- 13 Ersek JL, Eberth JM, McDonnell KK. , et al. Knowledge of, attitudes toward, and use of low-dose computed tomography for lung cancer screening among family physicians. Cancer 2016; 122 (15) 2324-2331
- 14 Yarnall KSH, Pollak KI, Østbye T, Krause KM, Michener JL. Primary care: is there enough time for prevention?. Am J Public Health 2003; 93 (04) 635-641
- 15 Østbye T, Yarnall KSH, Krause KM, Pollak KI, Gradison M, Michener JL. Is there time for management of patients with chronic diseases in primary care?. Ann Fam Med 2005; 3 (03) 209-214
- 16 Simmons VN, Gray JE, Schabath MB, Wilson LE, Quinn GP. High-risk community and primary care providers knowledge about and barriers to low-dose computed topography lung cancer screening. Lung Cancer 2017; 106: 42-49
- 17 Carter-Harris L, Brandzel S, Wernli KJ, Roth JA, Buist DSM. A qualitative study exploring why individuals opt out of lung cancer screening. Fam Pract 2017; 34 (02) 239-244
- 18 Marcotte L, Seidman J, Trudel K. , et al. Achieving meaningful use of health information technology: a guide for physicians to the EHR incentive programs. Arch Intern Med 2012; 172 (09) 731-736
- 19 Medicare C for. Baltimore MS 7500 SB, Usa M. PaymentAdj_Hardship; 2017. Available at: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/PaymentAdj_Hardship.html . Accessed August 18, 2017
- 20 Goldzweig CL, Orshansky G, Paige NM. , et al. Electronic patient portals: evidence on health outcomes, satisfaction, efficiency, and attitudes: a systematic review. Ann Intern Med 2013; 159 (10) 677-687
- 21 Smith SG, O'Conor R, Aitken W, Curtis LM, Wolf MS, Goel MS. Disparities in registration and use of an online patient portal among older adults: findings from the LitCog cohort. J Am Med Inform Assoc 2015; 22 (04) 888-895
- 22 The evolution of technology adoption and usage. Pew Res. Cent; 2017. Available at: http://www.pewresearch.org/fact-tank/2017/01/12/evolution-of-technology/ft_17-01-10_internetfactsheets/ . Accessed June 11, 2018
- 23 Mobile Fact Sheet. Pew Res. Cent. Internet Sci. Tech; 2017. Available at: http://www.pewinternet.org/fact-sheet/mobile/ . Accessed August 18, 2017
- 24 Technology Device Ownership; 2015 » Public Libraries Online. Available at: http://publiclibrariesonline.org/2015/12/technology-device-ownership-2015/ . Accessed August 18, 2017
- 25 Internet/Broadband Fact Sheet. Pew Res. Cent. Internet Sci. Tech; 2017. Available at: http://www.pewinternet.org/fact-sheet/internet-broadband/ . Accessed August 18, 2017
- 26 Fuchs C. Screening Centers of Excellence Designation. Lung Cancer Alliance. Available at: https://lungcanceralliance.org/for-professionals/screening-centers-of-excellence-designation/ . Accessed June 18, 2018
- 27 Miller Jr DP, Spangler JG, Case LD, Goff Jr DC, Singh S, Pignone MP. Effectiveness of a web-based colorectal cancer screening patient decision aid: a randomized controlled trial in a mixed-literacy population. Am J Prev Med 2011; 40 (06) 608-615
- 28 Miller Jr DP, Weaver KE, Case LD. , et al. Usability of a novel mobile health iPad app by vulnerable populations. JMIR Mhealth Uhealth 2017; 5 (04) e43 . Doi: 10.2196/mhealth.7268
- 29 Miller Jr DP, Denizard-Thompson N, Weaver KE. , et al. Effect of a digital health intervention on receipt of colorectal cancer screening in vulnerable patients: a randomized controlled trial. Ann Intern Med 2018; 168 (08) 550-557
- 30 Centers for Medicare & Medicaid Services. Final National Coverage Determination on Screening for Lung Cancer with Low Dose Computed Tomography (LDCT) (CAG-00439N); 2015. Available at: https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=274 . Accessed November 10, 2015
- 31 Bellinger CR, Pinsky P, Foley KL. , et al. A Lung cancer screening benefits and harms stratified by patient risk: information to improve patient decision aids. Ann Am Thorac Soc. Doi: White-201810-690RL.R1
- 32 Tammemägi MC, Katki HA, Hocking WG. , et al. Selection criteria for lung-cancer screening. N Engl J Med 2013; 368 (08) 728-736
- 33 Katki HA, Kovalchik SA, Petito LC. , et al. Implications of nine risk prediction models for selecting ever-smokers for computed tomography lung cancer screening. Ann Intern Med 2018; 169 (01) 10-19
- 34 Aberle DR, Berg CD, Black WC. , et al; National Lung Screening Trial Research Team. The National Lung Screening Trial: overview and study design. Radiology 2011; 258 (01) 243-253
- 35 Kramer BS, Berg CD, Aberle DR, Prorok PC. Lung cancer screening with low-dose helical CT: results from the National Lung Screening Trial (NLST). J Med Screen 2011; 18 (03) 109-111
- 36 Church TR, Black WC, Aberle DR. , et al; National Lung Screening Trial Research Team. Results of initial low-dose computed tomographic screening for lung cancer. N Engl J Med 2013; 368 (21) 1980-1991
- 37 Botsis T, Hartvigsen G, Chen F, Weng C. Secondary use of EHR: data quality issues and informatics opportunities. AMIA Jt Summits Transl Sci Proc 2010; 2010: 1-5
- 38 Orfanidis L, Bamidis PD, Eaglestone B. Data quality issues in electronic health records: an adaptation framework for the Greek Health System. Health Informatics J 2004; 10: 23-36
- 39 Chan KS, Fowles JB, Weiner JP. Review: electronic health records and the reliability and validity of quality measures: a review of the literature. Med Care Res Rev 2010; 67 (05) 503-527
- 40 Ali N, Lifford KJ, Carter B. , et al. Barriers to uptake among high-risk individuals declining participation in lung cancer screening: a mixed methods analysis of the UK Lung Cancer Screening (UKLS) trial. BMJ Open 2015; 5 (07) e008254
- 41 Lillie SE, Fu SS, Fabbrini AE. , et al. What factors do patients consider most important in making lung cancer screening decisions? Findings from a demonstration project conducted in the Veterans Health Administration. Lung Cancer 2017; 104: 38-44
- 42 Lau YK, Caverly TJ, Cao P. , et al. Evaluation of a personalized, web-based decision aid for lung cancer screening. Am J Prev Med 2015; 49 (06) e125-e129
- 43 Reuland DS, Cubillos L, Brenner AT, Harris RP, Minish B, Pignone MP. A pre-post study testing a lung cancer screening decision aid in primary care. BMC Med Inform Decis Mak 2018; 18 (01) 5
- 44 Fagerlin A, Pignone M, Abhyankar P. , et al. Clarifying values: an updated review. BMC Med Inform Decis Mak 2013; 13 (Suppl. 02) S8