The MyLungHealth Study Protocol: Engaging Patients to Enable Interoperable Lung Cancer Decision Support at Scale

The MyLungHealth Study Protocol: A Pragmatic Patient-Randomized Controlled Trial to Evaluate a Patient-Centered, Electronic Health Record-Integrated Intervention to Enhance Lung Cancer Screening in Primary Care

Early lung cancer screening (LCS) through low-dose computed tomography (LDCT) is crucial but underused due to various barriers, including incomplete or inaccurate patient smoking data in the electronic health record and limited time for shared decision-making. The objective of this trial is to investigate a patient-centered intervention, MyLungHealth, delivered through the patient portal. The intervention is designed to improve LCS rates through increased identification of eligible patients and informed decision making.

MyLungHealth is a multi-site pragmatic trial, involving University of Utah Health and New York University Langone Health primary care clinics. The MyLungHealth intervention was developed using a user-centered design process, informed by patient and provider focus groups and interviews. The intervention's effectiveness will be evaluated through a patient-randomized trial, comparing the combined use of MyLungHealth and DecisionPrecision+ (a provider-focused clinical decision support and shared decision-making intervention) against DecisionPrecision+ alone.

Inclusion criteria for both study 1 and study 2:

• aged 50-79
• a history of smoking (e.g., current or former tobacco use)
• seen in a study primary care clinic in the 12 months preceding the start of the trial

Exclusion criteria for both study 1 and study 2:

• >0 but < 10 pack-year smoking history or quit more than 15 years ago
• No use of the patient portal at least once in the year preceding the start of the study
• A lung cancer diagnosis at the start of the study
• LDCT completed in the past 3 years
• Another chest CT completed in the past year
• Structured EHR data indicating LCS SDM was provided in the past 3 years
• Exposed to the intervention during the pilot phase
• No visit at a study clinic during the trial period when the intervention was available

Inclusion criteria for study 1:

• a 10-19 pack-year smoking history, an unknown pack-year history, unknown quit date for patients who quit smoking, or a 0 pack-year smoking history

Inclusion criteria for study 2:

• at least a 20 pack-year smoking history and are a current smoker or have quit within the last 15 years