Factors associated with poor patient recall of lung cancer screening follow-up recommendations and the association with adherence

Abstract

Rationale. Factors associated with adherence to recommendations after initiating lung cancer screening (LCS) are poorly understood. We sought to determine patient-level factors associated with incorrect identification of LCS follow-up recommendations, hypothesizing that incorrect recall would be associated with decreased adherence to follow-up. Methods. We performed a cross-sectional study of patients in the University of Washington LCS registry who underwent initial LCS exam between June 2017- July 2018 (n=229). We excluded individuals with cognitive limitations and non-English speakers. Subjects were mailed a survey following initial LCS exam. Additional data was 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, Lung-RADS score, and method of results communication (letter, telephone or in-person). Adherence was defined as receipt of follow-up within 90 days of recommended interval by Lung-RADS 1.0 designation. Categorical variables were compared using chi-square tests and bivariate logistic regression. Multivariable logistic regression was used to estimate associations between incorrect identification of recommendations and adherence to follow-up, adjusting for demographics (age, race/ethnicity), smoking (current vs. former), and Lung-RADS score (<3 vs ≥3). Results. One-hundred two participants completed the survey (response rate 44.5%); 46 (45%) incorrectly identified their follow-up recommendation. In bivariate analyses, individuals who self-identified as male, current smokers, had lower educational attainment or lower income were less likely to correctly identify follow-up recommendations. The method of communicating LCS results and follow-up was not associated with incorrect identification of follow-up. Those with lung-RADS scores ≥3 were less likely to correctly identify follow-up recommendations compared to those with scores <3. Overall adherence to follow-up was 62%. Despite more incorrect responses in those with lung-RADS score ≥3, the majority of these participants (15/19, 79%) were adherent with follow-up. In adjusted models, incorrect identification of LCS recommendations was associated with decreased adherence to follow-up (OR=0.37, 95% CI: 0.14-0.96). Conclusion. This study is among the first to identify factors associated with incorrect identification of recommendations for LCS follow-up, and to find that incorrect identification is associated with less adherence to follow-up. These results can inform efforts to target improved education and navigation of LCS, potentially improving adherence.