Reminders Increase Lung Screening Follow-up

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.