{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T20:46:44Z","timestamp":1791578804373,"version":"4.3.4"},"reference-count":39,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Oncol"],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:sec>\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Lung cancer screening (LCS) with low-dose computed tomography (CT) remains underused in the US, partly because of incomplete smoking history documentation in electronic health records (EHRs) and limited time for shared decision-making in primary care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine whether a patient-facing, EHR-integrated tool combined with clinician-facing clinical decision support improves the identification of LCS-eligible patients and the ordering of low-dose CT compared with clinician-facing tools alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This pragmatic, unstratified, randomized clinical trial with parallel groups was conducted from March 29, 2024, to March 28, 2025, at primary care clinics at University of Utah Health and New York University Langone Health. Adults aged 50 to 79 years with a documented smoking history, an active patient portal account, and a primary care visit in the preceding year were included. Study 1 enrolled patients with uncertain LCS eligibility (10 to 19 pack-years, unknown pack-years, or missing quit date); study 2 enrolled patients with documented eligibility (20 or more pack-years and currently smoking or quit smoking within 15 years).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>The control included the clinician-facing Decision Precision+ tool (preventive care reminders and a shared decision-making tool). The intervention included the Decision Precision+ tool as well as the MyLungHealth tool, which collected detailed smoking history (study 1) and delivered personalized education and risk\/benefit information (studies 1 and 2) via the patient portal in English and Spanish.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>The primary outcomes were the proportion of patients newly identified as eligible for LCS (study 1) and low-dose CT ordering rates (study 2) over 12 months. Analyses used intention-to-treat mixed-effects logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There were 31\u202f303 randomized participants, including 26\u202f729 in study 1 (13\u202f144 [49.2%] female; 13\u202f580 [50.8%] male; median [IQR] age, 62 [55-69] years) and 4574 in study 2 (2230 [48.8%] female; 2344 [51.2%] male; median [IQR] age, 63 [56-69] years). In study 1, the MyLungHealth tool increased new LCS eligibility identification (635 of 13\u202f412 [4.7%] vs 308 of 13\u202f317 [2.3%]; adjusted odds ratio, 2.19; 95% CI, 1.99-2.42;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001). In study 2, low-dose CT ordering was higher in the intervention arm (474 of 2312 [20.5%] vs 434 of 2262 [19.2%]; adjusted odds ratio, 1.16; 95% CI, 1.04-1.30;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.008).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this randomized clinical trial, integrating a patient-centered tool into primary care EHR workflows increased the identification of patients eligible for LCS and the ordering of low-dose CTs. The relative increases in these primary outcomes were substantial, but absolute increases were more modest. Research on more intensive interventions is warranted to evaluate their ability to further improve LCS screening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov Identifier:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT06338592\">NCT06338592<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamaoncol.2025.5672","type":"journal-article","created":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T16:30:51Z","timestamp":1766766651000},"page":"167","source":"Crossref","is-referenced-by-count":4,"title":["Enhancement of Patient-Centered Lung Cancer Screening"],"prefix":"10.1001","volume":"12","author":[{"given":"Polina V.","family":"Kukhareva","sequence":"first","affiliation":[{"name":"Department of Biomedical Informatics, University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haojia","family":"Li","sequence":"additional","affiliation":[{"name":"Study Design and Biostatistics Center, University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Balbin","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth R.","family":"Stevens","sequence":"additional","affiliation":[{"name":"Department of Population Health, NYU Grossman School of Medicine, New York, New York"},{"name":"Medical Center Information Technology, Department of Health Informatics, NYU Langone Health, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devin M.","family":"Mann","sequence":"additional","affiliation":[{"name":"Department of Population Health, NYU Grossman School of Medicine, New York, New York"},{"name":"Medical Center Information Technology, Department of Health Informatics, NYU Langone Health, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorie M.","family":"Butler","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, University of Utah, Salt Lake City"},{"name":"Salt Lake City Veterans Administration Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center, Salt Lake City, Utah"},{"name":"Department of Internal Medicine, University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanner J.","family":"Caverly","sequence":"additional","affiliation":[{"name":"Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, Michigan"},{"name":"Department of Learning Health Sciences, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilherme","family":"Del Fiol","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly A.","family":"Kaphingst","sequence":"additional","affiliation":[{"name":"Department of Communication, University of Utah, Salt Lake City"},{"name":"Huntsman Cancer Institute, University of Utah Health, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chelsey R.","family":"Schlechter","sequence":"additional","affiliation":[{"name":"Huntsman Cancer Institute, University of Utah Health, Salt Lake City"},{"name":"Department of Population Health Sciences, University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria L.","family":"Tiase","sequence":"additional","affiliation":[{"name":"Department 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