Recruitment methods employed in the National Lung Screening Trial

Abstract

Objectives To report participant recruitment experiences in a large, US randomized controlled trial (RCT) of lung cancer screening, with the aim of providing information that may be of use to researchers who wish to conduct similar future studies. Setting The National Lung Screening Trial (NLST), an RCT that demonstrated a 20% lung cancer mortality reduction with low dose helical computed tomography screening, relative to single-view chest radiograph screening. Thirty-three US medical centres recruited 53,454 participants from August 2002 through April 2004. Methods After recruitment was completed, centre co-ordinators were asked to complete a questionnaire addressing the extent to which specific methods were used and, for each specific method, numbers enrolled and total cost of the effort. Cost per enrollee was calculated. Coordinators also were asked to report lessons learned. Results Twenty-two centres returned questionnaires. Use of recruitment method varied by centre. Among centres reporting number enrolled by method, about 19,000 participants were enrolled with direct mail, about 4200 with mass media, and about 1000 with community outreach. Cost per enrollee varied across centres but medians were (US)$101 (direct mail), $79 (mass media), and $4 (community outreach). Co-ordinators reported that it was important to know where to find persons likely to be eligible and interested, and how best to approach them. Conclusions Most NLST participants were recruited through direct mail, although median cost per participant was highest for that method.

The Cost-Effectiveness of High-Risk Lung Cancer Screening and Drivers of Program Efficiency

“…The protocol and initial results from the NLST are available in the literature. 27,28 We used demographic data from the NLST and calculated risk with the PLCO m2009 risk prediction; the PLCO m2009 risk prediction model is an earlier version of the PLCO m2012 model that was developed from the PLCO trial. 15,29 The PLCO series of models share similar predictors (i.e., age, education, smoking history, coexisting chronic obstructive pulmonary disease, family history of lung cancer, and body mass index), however, the PLCO m2012 also accounts for personal history of cancer and race/ethnicity.…”

Participation bias in a randomised trial of screening for lung cancer

“…Additionally, response rate to recruitment is low, e.g. in NELSON only 31.9% responded to the invitation [4] and in the US trial only 0.5% of those who received a letter of invitation eventually were included [10]. The differing methods and rates of recruitment may induce different degrees of participation bias, i.e.…”

Patient Perceptions of CT Imaging in a Diverse Patient Sample

“…Patient reporting of positive experiences while undergoing procedures promotes a better understanding and optimal use of advanced diagnostic tests, such as CT, and adherence to imaging-based screening [16,17]. Patients may not return or believe the results if they had a negative experience, were not properly informed, or both [10,18].…”