Patient Identification of Lung Cancer Screening Follow-up Recommendations and the Association with Adherence.

RATIONALE Adherence to follow-up lung cancer screening (LCS) in real-world settings is suboptimal. Patient understanding of screening results and anticipated follow-up may be crucial to adherence. OBJECTIVE To determine patient-factors associated with identification of follow-up recommendations as a measure of patient understanding of screening results after LCS , and to determine whether misidentification of follow-up is associated with lower adherence to recommendations. METHODS We performed a prospective study of patients in the University of Washington/Seattle Cancer Care Alliance LCS registry who underwent an initial LCS exam between June 2017- September 2019. We mailed potential participants a survey following initial LCS exam, with additional data abstracted from the electronic health record and LCS registry. Participants were asked to identify the timing and next step for their follow-up, with answers corresponding to Lung-RADS recommendations. We examined associations between incorrect identification of recommended follow-up and patient-level characteristics, self-perceived benefit/harm of LCS, LCS knowledge, Lung-RADS score, and patient-reported method of LCS results communication (letter, telephone or in-person). We used multivariable logistic regression to evaluate associations with incorrect identification of recommendations and assessed incorrect identification of recommendations as a potential mechanism for poor adherence in a separate regression model. RESULTS One-hundred eighty-eight participants completed the survey (response rate 44%); 47% misidentified their follow-up recommendation. Those with lung-RADS scores ≥3 had higher odds of incorrectly identifying follow-up recommendations compared to those with scores <3, as did those with lower educational attainment. However, there was no significant association between incorrect identification of follow-up and ultimate adherence to follow-up. CONCLUSION Understanding of LCS follow-up appears to be poor, especially among those with lower education levels and positive findings. Among survey responders, incorrect identification of follow-up was not associated with poor adherence, suggesting other factors, such as provider interventions, may be driving adherence behavior. These results can inform efforts to target improved patient education regarding follow-up for LCS. Primary sources of funding. American Lung Association and American Thoracic Society.