A100-06 Contextual Factors Influencing the Effectiveness of Multilevel Strategies on Annual Lung Cancer Screening and Diagnostic Follow-up

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Abstract Rationale Adherence to annual lung cancer screening (LCS) remains low and inequitable across the U.S., highlighting the critical need to develop effective strategies to ensure LCS benefits are translated into practice. As part of a larger pragmatic trial, this study sought to understand contextual factors shaping effectiveness of two such strategies. Methods We conducted a 2 x 2 factorial trial to test the individual and combined effects of patient (text message reminders) and clinician-directed (pended orders in medical record) strategies on LCS adherence compared to usual care. To explore the contextual influences shaping effectiveness, we surveyed and interviewed a subset of enrolled patients using a concurrent mixed-methods design, oversampling by race and stratifying by study outcome. Guided by the Consolidated Framework for Implementation Research, we examined how adherence was impacted by individual characteristics, inner and outer settings, and process-related constructs, including shared decision making. Qualitative data were analyzed using directed content analysis. Surveys were analyzed descriptively, and bivariate analyses were used to examine differences in patient characteristics and survey responses overall and by adherence. Quantitative and qualitative data were triangulated to assess areas of convergence, divergence, and complementarity. The study is supported by the NCCN through a grant provided by AstraZeneca. Results Of the 600 patients enrolled in the trial, we enrolled a total of 30 adults in the mixed methods study (46.4% Black Adults; See Table 1). Most patients had positive feedback about the text messages, describing them as helpful, caring, and motivating. When comparing patient characteristics by adherence, we observed significant differences by race and food insecurity. In interviews, most patients in both groups learned about LCS through clinician initiation, though some patients in the non-adherent group reported initiating discussion themselves. Clinician recommendations strongly influenced LCS completion for all, and most patients relied heavily on care teams for scheduling support. Trust in clinicians was high across groups, with no significant differences between groups (Table 1). Patients in the non-adherent group often reported communication lapses, such as not recalling instructions for annual screening or follow-up. Conclusion Our results indicate that multilevel approaches may be effective in increasing adherence overall and particularly for patients facing barriers, supported by trial success in Black adults and adults experiencing food insecurity. High levels of trust in and reliance upon clinician recommendation coupled with evidence of communication lapses indicate the need for interventions that clarify, strengthen and reinforce clinician communication related to LCS adherence. This abstract is funded by: This study is supported by NCCN through a grant provided by AstraZeneca.

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