Is Anybody Out There? Understanding the Reach of Lung Cancer Screening Health Communication Through EHR Patient Portal.

Health communication addressing individuals eligible for lung cancer screening (LCS) can increase screening uptake and adherence, which remain low in the U.S. Digital Communication via EHR patient portals offers a scalable solution, but face barriers related to portal access and use. We conducted a secondary analysis of a pragmatic clinical trial (Kaiser Permanente Washington, Nov 2022-Apr 2024) to identify gaps in access and engagement with an LCS health communication intervention delivered via portal message. We assessed factors associated with 1) patient portal access (all participants, n = 1837); and 2) opening the intervention message (intervention arm only, n = 820) using multivariate log binomial regression to calculate prevalence ratios (PRs) and confidence intervals (CIs). Most participants (89.6%) had access to the portal. No access was associated with current tobacco use (PR 0.4), neighborhood income <$50K (PR 0.3), and <5 years of insurance (PR 0.5). Among the intervention group, 81.2% opened the message. Not opening was associated with older age (PR 0.7), current tobacco use (PR 0.5), >1 well-care visit in the past year (PR 0.6), and 5-10 years of insurance (PR 0.5). While patient portals can broadly deliver LCS interventions, disparities in access and engagement suggest the need for alternative communication strategies.