C-Raven LDCT: Lung Cancer Screening Intervention

Smoking is associated with a dramatically increased risk of lung cancer, with rates 10-40 times higher among those who smoke than among those who do not smoke, with smoking accounting for about 85-90% of all lung cancer cases. Screening for lung cancer with low-dose computed tomography (LDCT) has been shown to significantly reduce lung cancer mortality in high-risk populations. Lung cancer screening with annual LDCT is therefore recommended by the US Preventive Services Task Force (USPSTF) for all adults aged 50 to 80 years with a 20 pack-year history of smoking who currently smoke or have quit within the past 15 years. However, in a nationwide study of individuals eligible for lung cancer screening in 2022, only 18% were up-to-date with the recommended screening.

The investigators propose a three-arm, randomized controlled pilot of a lung cancer screening intervention. Recruitment will be carried out primarily through the electronic health record, with invitations sent to patients aged 50-80 who have a documented history of smoking but no chest CT on file within the past 18 months. The investigators will also partner with community organizations such as senior centers and churches to distribute information about the study.

Potential participants will be screened for eligibility for lung cancer screening. If eligible, the participants will undergo a consent process, complete baseline surveys (demographics, etc.), and be randomized to one of the following three study conditions:

• Notification of eligibility for lung cancer screening with a recommendation to discuss with the participant's health care provider
• Animated video on shared decision-making for LDCT with accompanying guide, offered as a downloadable PDF or mailed hard copy, per individual preference
• Video and guide as in (b), plus a one-on-one call with a community health worker (CHW), 1-2 weeks after viewing the materials

Three months after receiving the intervention, follow-up surveys will be sent to assess attitudes toward and completion of lung cancer screening.

Inclusion criteria

• Existing record within the Johns Hopkins medical system
• Age 50-80
• Current tobacco use OR cessation within the past 15 years
• 20-pack year history of smoking
• No chest CT imaging within the past 18 months
• English speaking
• Willing to complete the study procedures, which include questionnaires and possibly a follow-up call

Exclusion criteria

• Not meeting eligibility criteria