Lung Screen Uptake Trial (LSUT): Randomized Controlled Clinical Trial Testing Targeted Invitation Materials

• Published in: American journal of respiratory and critical care medicine 2020-04, Vol.201 (8), p.965-975
• Main Authors: Quaife, Samantha L, Ruparel, Mamta, Dickson, Jennifer L, Beeken, Rebecca J, McEwen, Andy, Baldwin, David R, Bhowmik, Angshu, Navani, Neal, Sennett, Karen, Duffy, Stephen W, Wardle, Jane, Waller, Jo, Janes, Samuel M
• Format: Article
• Language: English
• Subjects: Aged; Breath Tests; Carbon Monoxide; Clinical trials; Early Detection of Cancer - methods; Ex-Smokers; Female; Health education; Humans; Lung cancer; Lung Neoplasms - diagnostic imaging; Male; Medical screening; Middle Aged; Original; Patient Compliance; Patient Selection; Primary care; Smokers; Socioeconomic Factors; Spirometry; Tomography, X-Ray Computed; United Kingdom
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.201905-0946OC

Low uptake of low-dose computed tomography (LDCT) lung cancer screening, particularly by current smokers of a low socioeconomic position, compromises effectiveness and equity. To compare the effect of a targeted, low-burden, and stepped invitation strategy versus control on uptake of hospital-based Lung Health Check appointments offering LDCT screening. In a two-arm, blinded, between-subjects, randomized controlled trial, 2,012 participants were selected from 16 primary care practices using these criteria: ) aged 60 to 75 years, ) recorded as a current smoker within the last 7 years, and ) no prespecified exclusion criteria contraindicating LDCT screening. Both groups received a stepped sequence of preinvitation, invitation, and reminder letters from their primary care practitioner offering prescheduled appointments. The key manipulation was the accompanying leaflet. The intervention group's leaflet targeted psychological barriers and provided low-burden information, mimicking the concept of the U.K. Ministry of Transport's annual vehicle test ("M.O.T. For Your Lungs"). Uptake was 52.6%, with no difference between intervention (52.3%) and control (52.9%) groups in unadjusted (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.82-1.16) or adjusted (OR, 0.98; 95% CI, 0.82-1.17) analyses. Current smokers were less likely to attend (adjusted OR, 0.70; 95% CI, 0.56-0.86) than former smokers. Socioeconomic deprivation was significantly associated with lower uptake for the control group only (