Lung Screen Uptake Trial (LSUT): Randomized Controlled Clinical Trial Testing Targeted Invitation Materials

Abstract

Rationale: Low uptake of low-dose CT (LDCT) lung cancer screening, particularly by current smokers of a low socioeconomic position, compromises effectiveness and equity. Objectives: To compare the effect of a ‘targeted, low burden and stepped’ invitation strategy versus control, on uptake of hospital-based ‘Lung Health Check’ appointments offering (LDCT) screening. Methods: A two-arm, blinded, between-subjects, randomised controlled trial. 2012 participants were selected from 16 primary care practices using these criteria: i) aged 60-75, ii) recorded as a current smoker within the last seven years, iii) no pre-specified exclusion criteria contraindicating LDCT screening. Both groups received a stepped sequence of pre-invitation, invitation and reminder letters from their Primary Care Practitioner offering pre-scheduled appointments. The key manipulation was the accompanying leaflet. The intervention group’s leaflet targeted psychological barriers and provided low burden information, mimicking the concept of the UK Ministry of Transport’s annual vehicle test (‘MOT for your lungs’). Measurements and Main Results: Uptake was 52.6%, with no difference between intervention (52.3%) and control (52.9%) groups in unadjusted (OR: 0.98, 0.82-1.16) or adjusted (aOR: 0.98, 0.82-1.17) analyses. Current smokers were less likely to attend (aOR: 0.70, 0.56-0.86) than former smokers. Socioeconomic deprivation was significantly associated with lower uptake for the control group only (p<.01). Conclusions: The intervention did not improve uptake. Regardless of trial arm, uptake was considerably higher than previous clinical and real world studies, particularly given the sample were predominantly lower socioeconomic position smokers. Strategies common to both groups, including a Lung Health Check approach, could represent a minimum standard.