Timely, Multilevel Reminders Sharply Improve Annual Lung Cancer Screening Adherence

A pragmatic randomized clinical trial found that pairing primary care order prompts with patient scheduling reminders increased adherence to annual lung cancer screening by nearly 28 percentage points. The workflow-based intervention moved screening completion beyond 75%—a notable gain for health systems seeking to translate low-dose computed tomography (LDCT) recommendations into sustained care.¹

Annual LDCT is recommended by the US Preventive Services Task Force (USPSTF) for adults aged 50 to 80 years with at least a 20 pack-year smoking history who currently smoke or quit within the past 15 years.² The clinical value is well established: the National Lung Screening Trial reported a 20% relative reduction in lung cancer mortality with LDCT compared with chest radiography.³ However, that benefit depends on patients returning for repeat screening, not merely completing an initial scan.

Stepped Reminders Outperform Education Alone

Investigators at Kaiser Permanente Washington enrolled 1837 patients who had normal findings on an index LDCT scan and randomly assigned them to usual care, health communication alone, “Stepped Reminders” alone, or both interventions.¹ The primary outcome was completion of screening LDCT or diagnostic chest CT 9 to 15 months after the index scan.

The Stepped Reminders pathway began approximately 4 weeks before screening was due. Primary care clinicians received an alert to order the examination; patients subsequently received portal and mailed messages directing them to schedule it. Adherence reached 75.5% among patients exposed to Stepped Reminders compared with 47.4% without them (relative risk [RR], 1.59; 95% CI, 1.47-1.72; P < .001).¹

Education delivered shortly after the index scan did not produce the same result. Patients receiving print or video health communication had lower adherence than those who did not receive it (59.2% vs 63.3%; RR, 0.93; 95% CI, 0.86-1.00; P = .04).¹ This contrast indicates that information alone—especially when delivered months before action is required—may be less effective than a precisely timed prompt connected to a clear next step.

Greater Benefit Among Current Tobacco Users

Nearly half of participants currently use tobacco. In this group, Stepped Reminders increased adherence from 41.2% to 73.0%, a 32.3–percentage point adjusted difference. Among former tobacco users, adherence increased from 52.9% to 77.8%, a 24.1–percentage point difference; the interaction was statistically significant (P = .03).¹

The health communication intervention also appeared to perform differently by sex: adherence among women was 54.4% with the intervention vs 63.4% without it, whereas rates among men were essentially unchanged.¹ These subgroup findings caution against assuming that standardized education will affect all patients similarly.

Because this was an integrated, predominantly White cohort already engaged in screening, applicability to more diverse or fragmented settings remains uncertain.

Pharmacy Teams Can Reinforce the Screening Loop

Medication histories and tobacco-use documentation can identify potentially eligible patients, while refill encounters, transitions-of-care calls, and population-health outreach offer opportunities to confirm whether annual LDCT has been ordered and scheduled. Pharmacists can also pair screening reminders with evidence-based tobacco-cessation counseling and pharmacotherapy without making cessation a prerequisite for screening.

The trial’s practical message is that timing and task design matter. A reminder is most actionable when the clinician can place the order, and the patient can schedule the scan. Embedding those linked steps into electronic health record registries, closing referral loops, and tracking completion may allow pharmacy and multidisciplinary teams to convert screening eligibility into the repeated adherence required to reduce lung cancer mortality.

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. US Preventive Services Task Force, Krist AH, Davidson KW, et al. Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;325(10):962-970. doi:10.1001/jama.2021.1117

3. National Lung Screening Trial Research Team, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395-409. doi:10.1056/NEJMoa1102873