Health Communication and Stepped Reminders Interventions for Lung Cancer Screening: A Randomized Clinical Trial
Stepped reminders to clinicians and patients substantially improved annual lung cancer screening completion.
*Pragmatic factorial randomized clinical trial; Level 1b (OCEBM).
Citation
Wernli KJ, Anderson ML, Palazzo L, et al. JAMA Internal Medicine. Published August 10, 2026. doi:10.1001/jamainternmed.2026.3666
Background
Annual lung cancer screening with low-dose computed tomography reduces lung cancer deaths, but repeat yearly screening is often missed. This trial tested whether patient education and timed reminders could improve follow-up after a normal scan.
Patients
Adults aged 50 to 78 years in Kaiser Permanente Washington who had a normal or benign lung cancer screening scan. Exclusions included prior lung cancer, missing tobacco history, non-English or non-Spanish interpreter need, and research opt-out.
Intervention
Health communication with mailed or portal education and video; stepped reminders with pended scan orders for primary care clinicians plus patient portal, mail, and phone scheduling outreach.
Control
Usual care, including electronic record reminders visible to clinicians.
Outcome
Completion of annual screening scan or chest computed tomography.
Follow-up Period
9 to 15 months after the index scan.
Results
| Outcome | Comparison | Result | Practical effect |
|---|---|---|---|
| Annual screening completion (primary) | Stepped reminders vs no reminders | 75.5% vs 47.4%; RR 1.59 (95% CI 1.47 to 1.72); +27.7 percentage points (95% CI 23.2 to 32.1) | About 4 patients need reminders for one additional completed screen. |
| Annual screening completion (primary) | Health communication vs none | 59.2% vs 63.3%; −4.7 percentage points (95% CI −9.1 to −0.3) | No benefit; possible small reduction. |
Results used a modified intention-to-treat analysis. Usual care was the available current treatment in this system.
Limitations
The study was conducted in one integrated health system with mostly insured White patients, limiting generalizability. Only English and Spanish speakers were included. Costs were not evaluated, and video engagement was not measured for each participant.
Funding
National Cancer Institute; no funder role reported.
Clinical Application
For eligible screened patients with normal findings, build timed clinician order prompts plus patient scheduling outreach; do not rely on one-time education alone.
Discussion
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In this pragmatic 2×2 factorial randomized clinical trial, Stepped Reminders increased annual lung cancer screening adherence from 47.4% to 75.5% (RR 1.59; risk difference 27.7 percentage points); how convincing and applicable is this for adopting PCP/patient reminders in your setting? In this randomized trial, the Stepped Reminders intervention had a relative risk of 1.59 and an absolute risk difference of 27.7 percentage points for annual lung cancer screening adherence. Which statement best explains why the absolute risk difference is especially useful clinically?