近日，美国维克森林大学医学院David P. Miller团队研究了肺癌筛查的直达患者数字健康计划。相关论文发表在2025年10月20日出版的《美国医学会杂志》上。

胸部计算机断层扫描（CT）筛查可以降低高危人群的肺癌死亡率，但在美国，只有不到20%的符合条件人群接受了筛查。

为了确定直接面向患者的数字健康计划是否会增加肺癌筛查，研究组进行了一项随机临床试验，招募年龄在50至77岁之间，符合医疗保险和医疗补助服务中心标准的肺癌筛查标准，于2022年4月18日至2023年5月30日在美国东南部的两个学术卫生系统进行。最后一次追踪的日期是2024年9月30日。

将参与者以1:1的比例随机分配到mPATH-Lung项目，这是一个在临床访问之外提供的数字健康项目，包括简短的决策辅助和请求筛查预约的选择（n=669）或加强常规护理，其中患者被告知其肺癌筛查资格，并建议与其初级保健临床医生交谈（n = 664）。主要结局是在16周内完成任何胸部CT检查。次要结局包括筛查决策、过程测量（筛查就诊、CT扫描预约）、临床结果（肺癌筛查结果、肺癌诊断）、筛查危害和实施结果。

研究组向电子健康记录中有吸烟史的26909名个体发送电子邀请函，其中3267人完成网站资格问卷，1333人符合条件并完成入组。研究对象平均年龄60.7岁（标准差6.8岁）；女性864人（65%）；黑人232人（17%），非西班牙裔白人1054人（79%）；拥有商业保险621人（47%），公共保险595人（45%）。mPATH-肺癌干预组的胸部CT检查完成率高于对照组（24.5% [164/669] vs 17.0% [113/664]；比值比1.6；95%置信区间1.2-2.1）。在完成筛查CT的受试者中，mPATH-肺癌组假阳性率为12.7%（19/150），对照组为8.4%（8/95）。干预组有2.0%（3/150）接受侵入性操作，对照组为1.1%（1/95），均无并发症发生。

研究结果表明，与增强的常规护理相比，直接面向患者的数字健康干预提高了肺癌筛查率。未来的研究应评估数字化肺癌筛查干预措施在不同人群和卫生保健环境中的覆盖范围和有效性。

附：英文原文

Title: A Direct-to-Patient Digital Health Program for Lung Cancer Screening: A Randomized Clinical Trial

Author: David P. Miller, Anna C. Snavely, Ajay Dharod, Alison T. Brenner, Elena Wright, Lindsay Stradtman, Christina R. Bellinger, Richa Bundy, Robert J. Volk, Emily Hamburger, Renée M. Ferrari, Aliza Randazzo, Daniel S. Reuland

Issue&Volume: 2025-10-20

Abstract:

Importance  Screening chest computed tomography (CT) scans reduce lung cancer mortality in high-risk individuals, but less than 20% of eligible individuals are screened in the US.

Objective  To determine whether a direct-to-patient digital health program increases lung cancer screening.

Design, Setting, and Participants  Randomized clinical trial enrolling individuals aged 50 to 77 years who met Centers for Medicare & Medicaid Services criteria for lung cancer screening between April 18, 2022, and May 30, 2023, at 2 academic health systems in the southeastern US. The date of last follow-up was September 30, 2024.

Interventions  Participants were randomized 1:1 to the mPATH-Lung program, a digital health program delivered outside a clinical visit that included a brief decision aid and option to request a screening appointment (n=669) or enhanced usual care, in which patients were notified of their lung cancer screening eligibility and advised to speak with their primary care clinician (n=664).

Main Outcomes and Measures  The primary outcome was completion of any chest CT within 16 weeks. Secondary outcomes included screening decisions, process measures (screening visits, CT scans ordered), clinical outcomes (lung cancer screening results, lung cancers diagnosed), screening harms, and implementation outcomes.

Results  Electronic invitations were sent to 26909 individuals with a smoking history in their electronic health record; 3267 completed website eligibility questions and 1333 were deemed eligible and enrolled. The mean age was 60.7 years (SD, 6.8 years); 864 (65%) were female; 232 (17%) were Black and 1054 (79%) were non-Hispanic White; and 621 (47%) had commercial insurance and 595 (45%) had public insurance. Chest CT completion was higher in the mPATH-Lung group than in controls (24.5% [164/669] vs 17.0% [113/664]; odds ratio, 1.6; 95% CI, 1.2-2.1). Among patients who completed screening CT, false-positive results occurred in 12.7% (19/150) of mPATH-Lung participants and 8.4% (8/95) of controls. Invasive procedures were performed in 2.0% (3/150) in the intervention group and 1.1% (1/95) in the control group, with no complications.

Conclusions and Relevance  Compared with enhanced usual care, a direct-to-patient digital health intervention increased rates of lung cancer screening. Future research should assess the reach and effectiveness of digital lung cancer screening interventions across diverse populations and health care settings.

DOI: 10.1001/jama.2025.17281

Source: https://jamanetwork.com/journals/jama/fullarticle/2840346