Increasing uptake of lung cancer screening through a patient 'nudge': A randomized pragmatic trial.

INTRODUCTION: Population-level benefits of lung cancer screening (LCS) depend upon high participation, yet uptake remains low because of patient-, provider-, and system-level barriers. This study evaluated whether a pre-visit patient "nudge" increases LCS uptake. STUDY DESIGN: Patients were randomized by birth-month into intervention (IG) and usual care (UC) groups. SETTING/PARTICIPANTS: Kaiser Permanente Colorado patients eligible for LCS who had not completed baseline LCS low dose computed tomography (LCS-LDCT) screening and had a scheduled primary care physician (PCP) visit between 3/19/2024 and 10/8/2024 were randomized. Data were collected through 11/20/2024. INTERVENTION: Patients in the IG received an electronic or mailed letter encouraging LCS discussion with their PCP. MAIN OUTCOME: Receipt of an LCS-LDCT order. RESULTS: Analyses were conducted in 2024-2026. A total of 894 patients were randomized: 456 (51%) to IG and 438 (49%) to UC. Overall, 728 completed their visit (359 (49%) IG and 369 (51%) UC; P=0.69). Among those completing their visit, same-day LCS-LDCT ordering was similar (15% vs 18%; P=0.30) as were LCS-LDCT completion rates (7.0% vs 7.2% of completed visits [P=0.92]; 39% vs 48% of orders [P=0.34]). By follow-up end, more UC patients received an LCS-LDCT order (41% vs 38%; P=0.36). CONCLUSIONS: A low-intensity pre-visit patient nudge did not increase LCS-LDCT orders but was feasible to implement and allowed outreach strategy adaptations. Future refinements should optimize timing and integrate outreach with existing patient communications like appointment reminders to improve patient reach and engagement with patient-provider SDM discussions. TRIAL REGISTRATION: This study was registered at www. CLINICALTRIALS: Gov (NCT06474611).