This secondary analysis of a pragmatic randomised trial tested digital outreach for lung cancer screening eligibility in North Carolina. Adults aged 50 to 77 with a smoking history were invited by patient portal message or text. Of 26,909 invited, 3,049 (11%) completed eligibility questions within 16 weeks. Portal messages were read by 65.5% of recipients; adding texts raised those reached from 2,445 to 3,409. Reach was 12.8% in White, 8.6% in Black and 8.0% in Hispanic participants. Reach was also higher in women and urban residents. Only completion of eligibility questions was measured, not subsequent screening or outcomes.
Why it is interesting: Quantifies how far portal and text outreach reaches across a whole eligible population. The socio-demographic gradient in response shows where digital-first strategies under-perform.
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