The Reach and Feasibility of an Interactive Lung Cancer Screening Decision Aid Delivered by Patient Portal

Abstract

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.

What Works in Implementing Patient Decision Aids in Routine Clinical Settings? A Rapid Realist Review and Update from the International Patient Decision Aid Standards Collaboration

“…Eight articles provide support for this theory. 13 , 14 , 34 , 36 , 39 , 51 , 52 , 59 Many patients are unfamiliar with PtDAs and have no experience of using them to support their health care decisions. When explicit invitations to engage with the PtDA are sent to patients before the decision-making consultation, this acts as a prompt for the patient and increases the likelihood that they will use the PtDA.…”

“… 34 For instance, Berry et al 34 found that PtDA use increased from 0% to 14% in sites that provided written material suggesting access, compared with 82% to 87% in sites in which patient care coordinators or physicians provided direct email or telephone invitations to engage. Both Dharod et al 36 and Krist et al 39 found that digital delivery of reminders and PtDAs via patient portals was a successful strategy to increase usage. Invitations that explain the purpose of the PtDA, and SDM more broadly, better prepare and “activate” patients as they help them to understand the relevance of the PtDA and their own role in decision making, resulting in increased engagement with the PtDA and in SDM discussions during consultations.…”

“…Fourteen articles contributed data to this theory. 33 – 36 , 39 , 40 , 43 – 47 , 53 , 57 , 59 PtDAs are typically being implemented in settings characterized by limited staff resources, multiple competing demands and priorities, short appointment times, and, sometimes, short time frames within which to deliver the PtDA, so that it is feasible for the patient to use as intended and relevant. When teams were able to embed processes that could preidentify eligible patients and standardize (ideally automate) the delivery of the PtDA before the decision-making consultations, this resulted in improved reach of the PtDA to the right patient at the right time.…”

Electronic Health Record Portal Messages and Interactive Voice Response Calls to Improve Rates of Early Season Influenza Vaccination: Randomized Controlled Trial

“…In a study [ 51 ] of colorectal cancer screening reminders delivered via patient portal, among the 552 patients randomized to receive messages, 54% viewed the message and 9% performed a suggested web-based risk assessment tool. In a study describing the reach and feasibility of an interactive lung cancer screening decision aid delivered by patient portal, Dharod and colleagues [ 52 ] found that 86% of lung cancer screening eligible patients identified by an electronic health record algorithm to receive a patient portal message read the message, 40% then visited a web-based decision aid for lung cancer screening, and 35% completed questionnaires to determine their eligibility for lung cancer screening.…”

Practice, clinician, and patient factors associated with the adoption of lung cancer screening

“…Complex eligibility criteria can discourage providers from properly identifying eligible patients and practices from creating electronic alerts, reminders, and overdue care reports. [9][10][11] Patients and clinicians are concerned about high rates of false positives and extra-pulmonary findings. 2,9,[12][13][14][15] CMS coverage requires documentation of shared decision-making prior to screening, which is time consuming.…”