Understanding Patient Perspectives on Digital Smoking History Data Collection

Background: Lung cancer screening with an annual low-dose CT scan is recommended by the US Preventive Services Task Force for high-risk patients based on age (50-80 years of age) and smoking history (≥ 20 pack-years). Inaccurate smoking history data in the electronic health record (EHR) pose a challenge to identifying eligible patients. Digital strategies to collect patient-generated health data (PGHD) are a potential solution to elicit complete smoking histories directly from patients to then integrate into their EHR. Research Question: How do patients perceive and experience the use of digital outreach strategies to collect smoking history data to determine lung cancer screening eligibility? Study Design and Methods: As part of a quality improvement initiative, semistructured qualitative interviews were completed with a diverse group of patients who had received a request to complete a digital smoking history survey. Rapid analytical methods were used. Results: We completed 20 interviews with patients who did (n = 9) and did not (n = 11) complete the digital smoking history survey. Participants described varied preferences for digitally self-updating their smoking histories. Four themes emerged regarding barriers to uptake including (1) participants prefer to update their health record with a clinician, (2) technologic barriers influence participant engagement with digital PGHD collection strategies, (3) multiple options for collecting smoking frequency are needed to align with a variety of behaviors, and (4) participants have mixed perceptions of the value of accurate and updated EHR smoking data. Interpretation: Our findings highlight the need to address barriers to collection of digital PGHD to optimize reach and uptake. Using PGHD to obtain an updated and accurate smoking history has important implications, and incorporating patient education, strategies to overcome technologic barriers, and multiple metric options to collect smoking history may improve use.