Optimizing adherence to lung cancer screening: Applying theory and implementation science to participant engagement - PROJECT SUMMARY
Lung cancer is the leading cause of cancer death in the US, with most lung cancer diagnosed at advanced
stages. Low-dose CT screening of high-risk individuals is the only evidence-based tool available to diagnose
lung cancer at an early stage when curable treatment options exist. The promising mortality reduction benefit of
lung cancer screening (LCS) is presently overwhelmingly unfulfilled due to suboptimal population-based
adherence to annual screening guidelines. Outside of research settings, adherence to annual LCS is less than
half of the rates observed in the practice-changing, landmark clinical trials. There is an urgent need for effective
and feasible interventions to improve LCS adherence and achieve optimal individual and population health
benefits. Research during the F99 phase will leverage an innovative, multi-phase, mixed methods design to
describe how LCS patients process health information regarding health protective behavior and utilize this
information to develop and evaluate reminder messages with individuals eligible for LCS. Using a four-step
process, data collected in a survey of LCS program participants (step 1) will inform the development of a pool of
candidate reminder messages (step 2). In the final two steps, the reminder messages will be evaluated by LCS
experts (step 3) and further evaluated and refined with LCS program participants (step 4) using mixed methods,
including surveys and interviews. Differences between health information processing constructs by demographic
or clinical characteristics found to be significant from step 1 will be the focus for message targeting (group level)
and/or tailoring (individual level). At the conclusion of the F99 phase, I will have a formalized set of clear,
engaging, and efficient messages to support LCS annual adherence, ready to be evaluated in a clinical setting.
Research proposed in the K00 phase will focus on gaining real-world experience with hybrid effectiveness
implementation study designs and pragmatic outcome measures to simultaneously assess effectiveness and
implementation outcomes. Specifically, I propose a mentored pre-post type 1 hybrid effectiveness-
implementation trial, within a parent trial, that will allow concurrent assessment of effectiveness and
implementation outcomes of the F99 reminder strategy in real-world LCS programs. Effectiveness will be tested
using a pre-post design, comparing percent screening participants adherent to annual screening guidelines
before and after implementation of the reminder strategy. Secondary implementation outcomes (i.e.,
acceptability and feasibility) will be assessed with surveys and key informant interviews of personnel involved in
the reminder system implementation (e.g., LCS program directors, navigators, coordinators). This body of
research will prepare me for a career as an independent cancer-focused intervention scientist with expertise in
the development and implementation of effective, low-burden interventions aimed at improving LCS adherence,
maximizing screening benefit, and reducing lung cancer mortality.
