BACKGROUND
Approximately 14 million individuals in the U.S. are eligible for lung cancer screening (LCS), but only 5.8% completed screening in 2021. Given the low uptake despite the potential great health benefit of LCS, interventions aimed at increasing uptake are warranted.
OBJECTIVE
This study sought to develop and pilot an electronic health record (EHR) patient-facing self-referral tool to an established LCS program in an academic medical center.
METHODS
Guided by constructs of the Health Belief Model associated with LCS uptake (e.g., knowledge, self-efficacy), formative development of an EHR-delivered engagement message, infographic, and self-referring survey was conducted. The survey submits eligible self-reported patient information to a scheduler for the LCS program. The materials were pretested using an interviewer-administered mixed-methods survey captured through venue-day-time sampling in five network-affiliated pulmonology clinics. Materials were then integrated into the secure patient messaging feature in the EHR system. Next, a one-group posttest quality improvement pilot test was conducted.
RESULTS
Seventeen individuals presenting for lung screening shared-decision visits completed the pretest survey. More than half were newly referred for LCS (n=10, 58.8%), and the remaining were returning patients. When asked if they would use a self-referring tool through their EHR messaging portal, 94.12% (n=16) reported yes. Fifteen participants provided oral feedback that led to refinement in the tool and infographic prior to pilot testing. When the initial application of the tool was sent to a convenience sample of 150 random patients, 13.3% (n=20) opened the self-referring survey. Of the 20, 45.0% (n=9) were eligible for LCS based on self-reported smoking data. Three self-referring individuals scheduled a LCS.
CONCLUSIONS
Pretest and initial application data suggest this tool is a positive stimulus to trigger the decision-making process to engage in self-referral process to LCS among eligible patients. This self-referral tool may increase the number of patients engaging in LCS and could also be used to aid in self-referral to other preventative health screenings.