Integrating Telehealth to Advance Lung Cancer Screening

NCT ID: NCT06638554

Last Updated: 2025-11-12

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

6000 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-07-09

Study Completion Date

2027-01-31

Brief Summary

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The goal of this pragmatic trial is to learn if telehealth strategies can increase shared decision-making (SDM) for lung cancer screening (LCS). It will also learn about the equity of these strategies by conducting non-inferiority analysis by race and sex. The main questions it aims to answer are:

1. Does patient outreach using synchronous and asynchronous telehealth strategies increase completion of SDM visits for LCS?
2. Is the effectiveness of these telehealth strategies similar by race and sex?

The study uses a Sequential Multiple Assignment Randomized Trial (SMART) design and includes two stages of interventions. The first stage of intervention includes direct patient outreach with an invitation to schedule either a 1) telehealth SDM visit or 2) telehealth or in-person SDM visit. Participants that do not respond to the first stage interventions receive a text message reminder encouraging SDM visit completion with or without digital care coordination.

Detailed Description

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Annual lung cancer screening using low-dose computed tomography (LDCT) is associated with decreased lung cancer mortality but also with harms. As such, it is recommended, and required for reimbursement, that patients complete an shared decision-making visit (SDM) prior to screening to discuss potential risks and benefits in the context of patient values. Despite guidelines recommending screening and national insurance coverage of LDCT, uptake of SDM visits and subsequent LDCT is remarkably low. We aim to address these gaps by comparing the effectiveness of synchronous and asynchronous telehealth strategies on SDM visits and subsequent LDCT in a pragmatic trial using a Sequential Multiple Assignment Randomized Trial (SMART) design. The specific first stage strategies to be tested are: a) Active Choice Outreach (invitation to schedule a telehealth or in-person SDM visit) vs b) Telehealth Only Outreach (invitation to schedule a telehealth SDM visit). The specific second stage strategies (delivered only if participants do not respond to first stage interventions) are a) text message reminders encouraging SDM visit completion (low-touch) alone or b) in combination with phone-based digital care coordination (high-touch). We will also assess non-inferiority of strategies by race and sex to assess equity of effectiveness.

Conditions

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Early Detection of Cancer Telemedicine Decision Making

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SEQUENTIAL

This study uses a sequential randomization design in which all eligible participants will be randomized into one of two interventions at Stage 1 and then participants that do not respond to Stage 1 interventions will be randomized to receive Stage 2 interventions
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Active Choice (Stage 1) + Low Touch (Stage 2)

Participants in this arm will be offered the option via outreach letter to complete an SDM visit via telehealth or in-person (Stage 1) and if individuals do not schedule an SDM visit within 30 days (non-responders), they will receive asynchronous text messages alone (Stage 2)

Group Type EXPERIMENTAL

Active Choice

Intervention Type BEHAVIORAL

The participant will be send a letter inviting them to complete a SDM visit either in-person or via telehealth.

Low Touch Strategy

Intervention Type BEHAVIORAL

Patient will be sent asynchronous text messaging reminders encouraging SDM for LCS using framed messaging.

Active Choice (Stage 1) + High Touch (Stage 2)

Participants in this arm will be offered the option via outreach letter to complete an SDM visit via telehealth or in-person (Stage 1) and if individuals do not schedule an SDM visit within 30 days (non-responders), they will receive asynchronous text messages in combination with synchronous digital care coordination (Stage 2).

Group Type EXPERIMENTAL

Active Choice

Intervention Type BEHAVIORAL

The participant will be send a letter inviting them to complete a SDM visit either in-person or via telehealth.

High Touch Strategy

Intervention Type BEHAVIORAL

Patient will be sent asynchronous text messaging reminders encouraging SDM for LCS using framed messaging in combination with synchronous telephone-based digital care coordination.

Telehealth Only (Stage 1) + Low Touch (Stage 2)

Participants in this arm will be offered the option via outreach letter to complete an SDM visit via telehealth only (Stage 1) and if individuals do not schedule an SDM visit within 30 days (non-responders), they will receive asynchronous text messages alone (Stage 2).

Group Type EXPERIMENTAL

Telehealth Only

Intervention Type BEHAVIORAL

The participant will be send a letter inviting them to complete a SDM visit via telehealth only.

Low Touch Strategy

Intervention Type BEHAVIORAL

Patient will be sent asynchronous text messaging reminders encouraging SDM for LCS using framed messaging.

Telehealth Only (Stage 1) + High Touch (Stage 2)

Participants in this arm will be offered the option via outreach letter to complete an SDM visit via telehealth only (Stage 1) and if individuals do not schedule an SDM visit within 30 days (non-responders), they will receive asynchronous text messages in combination with synchronous digital care coordination (Stage 2).

Group Type EXPERIMENTAL

Telehealth Only

Intervention Type BEHAVIORAL

The participant will be send a letter inviting them to complete a SDM visit via telehealth only.

High Touch Strategy

Intervention Type BEHAVIORAL

Patient will be sent asynchronous text messaging reminders encouraging SDM for LCS using framed messaging in combination with synchronous telephone-based digital care coordination.

Interventions

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Active Choice

The participant will be send a letter inviting them to complete a SDM visit either in-person or via telehealth.

Intervention Type BEHAVIORAL

Telehealth Only

The participant will be send a letter inviting them to complete a SDM visit via telehealth only.

Intervention Type BEHAVIORAL

Low Touch Strategy

Patient will be sent asynchronous text messaging reminders encouraging SDM for LCS using framed messaging.

Intervention Type BEHAVIORAL

High Touch Strategy

Patient will be sent asynchronous text messaging reminders encouraging SDM for LCS using framed messaging in combination with synchronous telephone-based digital care coordination.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

Participants will be eligible if:

1. are aged 50 to 80
2. have a history of tobacco use indicated by either: Documented 20 pack-year or greater smoking history in their electronic health record (EHR); OR Self-report via structured survey
3. currently smoke or formerly smoked cigarettes
4. have no documented history of lung cancer
5. have no documented history of lung cancer screening in the 24 months prior to study enrollment
6. have completed at least one primary care visit at Penn Medicine in the 3 years prior to study enrollment.
Minimum Eligible Age

50 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institutes of Health (NIH)

NIH

Sponsor Role collaborator

National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

Abramson Cancer Center at Penn Medicine

OTHER

Sponsor Role lead

Responsible Party

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Katharine Rendle

Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Katharine Rendle, PhD

Role: PRINCIPAL_INVESTIGATOR

Abramson Cancer Center

Locations

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University of Pennsylvania

Philadelphia, Pennsylvania, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Katharine Rendle, PhD

Role: CONTACT

Phone: 215-349-5442

Email: [email protected]

Hannah Toneff, MSW, MA

Role: CONTACT

Phone: 267-882-3186

Email: [email protected]

Facility Contacts

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Katharine Rendle, PhD,MSW,MPH

Role: primary

Hannah Toneff, MSW, MA

Role: backup

Other Identifiers

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P50CA271338

Identifier Type: NIH

Identifier Source: secondary_id

View Link

850376

Identifier Type: OTHER

Identifier Source: secondary_id

UPCC 04524

Identifier Type: -

Identifier Source: org_study_id