Reminders for Primary Care Physicians, Patients Improved Annual Lung Cancer Screening Adherence

A multilevel reminder intervention directed to primary care physicians and patients significantly improved adherence to annual lung cancer screening with low-dose computed tomography (LDCT), according to findings from a randomized clinical trial published in JAMA Internal Medicine.¹

The Larch trial included 1837 Kaiser Permanente Washington members aged 50 to 78 years who had completed lung cancer screening with normal findings between November 2022 and April 2024. Participants were randomly assigned to usual care, a health communication intervention, a Stepped Reminders intervention, or both interventions.¹

The primary outcome was completion of screening LDCT or chest CT 9 to 15 months after the index LDCT. In adjusted analyses, participants who received the Stepped Reminders intervention were 27.7 percentage points more likely to adhere to annual lung cancer screening than those who did not receive reminders, at 75.5% vs 47.4% (relative risk, 1.59; 95% CI, 1.47-1.72; P<.001).¹

What was the Stepped Reminders intervention?

The Stepped Reminders intervention was designed to address both clinician and patient workflow barriers. Approximately 4 weeks before a patient’s annual screening due date, a lung cancer screening coordinator pended LDCT orders for the patient’s PCP to sign. After the order was signed, patients received outreach through the patient portal and mailed letters reminding them to schedule their scan. If patients did not schedule, the coordinator followed up by phone.¹

The approach also had high workflow uptake. Among patients randomized to Stepped Reminders, PCPs signed 585 of 613 pended orders, or 95.4%. Among participants who were not censored before the analytic window, 79.1% scheduled LDCT, and 68.9% of those who scheduled did so without needing a telephone call.¹

“We worked really closely with Kaiser Permanente Washington patients, clinicians, and leadership to develop our interventions and seamlessly integrate them into routine care during the study to make it easy to do the right thing,” Karen Wernli, PhD, senior investigator at Kaiser Permanente Washington Health Research Institute and lead study author, said in an accompanying press release.²

How did reminders affect patients currently using tobacco?

The effect was especially pronounced among participants currently using tobacco. In this subgroup, 73.0% of participants who received Stepped Reminders completed annual screening compared with 41.2% of those who did not receive the intervention, for a risk difference of 32.3 percentage points (95% CI, 25.9-38.8). Among former tobacco users, adherence was 77.8% with Stepped Reminders vs 52.9% without reminders, for a risk difference of 24.1 percentage points (95% CI, 18.1-30.0; P for interaction=.03).¹

“These findings were particularly notable because people with a significant tobacco history often experience stigma and stop engaging in health care,” Wernli said in the KPWHRI release. “Our results demonstrate that standard, consistent messaging overcomes some of those gaps.”²

Did patient education alone improve screening adherence?

The health communication intervention did not improve annual screening adherence. This intervention included print and video messaging delivered 3 weeks after the index scan and focused on the importance of lung cancer screening, the need to return in 12 months, and social support for screening.¹

In the primary analysis, adherence was lower among participants who received the health communication intervention than among those who did not, at 59.2% vs 63.3% (relative risk, 0.93; 95% CI, 0.86-1.00; P=.04).¹

The authors noted that improving short-term knowledge alone may be insufficient to overcome health system barriers. They suggested that future communication interventions may be more effective if delivered during shared decision-making or closer to the time patients are due for their next scan.¹

Why is this relevant to primary care?

Annual lung cancer screening with LDCT reduces lung cancer mortality, but adherence remains low. The study authors noted that an estimated 14.5 million US adults are eligible for lung cancer screening, yet national adherence to annual screening ranges from 22% to 50%.¹

The findings suggest that a structured, system-supported reminder workflow may improve repeat screening in PCP-led lung cancer screening programs. The intervention was embedded in routine care and combined PCP-facing order prompts with patient-facing scheduling outreach, an approach that may help reduce missed annual screening opportunities.¹

The trial population was predominantly White and insured, which may limit generalizability to other practice settings. The study also included only English- and Spanish-speaking patients and did not evaluate implementation costs. Still, investigators concluded that integrating intentional, multilevel reminders into lung cancer screening workflows may be essential for achieving the population-level mortality benefit of screening in PCP-led programs.¹

References

1. Wernli KJ, Anderson ML, Palazzo L, et al. Health communication and stepped reminders interventions for lung cancer screening: a randomized clinical trial. JAMA Intern Med. Published online August 10, 2026. doi:10.1001/jamainternmed.2026.3666
2. Ramsey S. Doctor and patient reminders improve lung cancer screening. Kaiser Permanente Washington Health Research Institute. News release. Published August 10, 2026. Accessed August 14, 2026. https://www.kpwashingtonresearch.org/news-and-events/recent-news/news-2026/doctor-patient-reminders-improve-lung-cancer-screening