JMIR Publications

ABSTRACT

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.