Our Peer-Reviewed Evidence
Evidence
Our Peer-Reviewed Evidence
mPATH has over a dozen publications in the nation’s leading medical journals which validate our behavioral science approach and prove mPATH works for patients and clinical partners.
mPATH-Lung Boosts Lung Cancer Screening in Real-World Settings
Lessons from: “A Direct-to-Patient Digital Health Program for Lung Cancer Screening: A Randomized Clinical Trial” JAMA, October 2025
Summary:This large randomized clinical trial tested whether mPATH-Lung, a direct-to-patient digital health program, could increase lung cancer screening outside of clinic visits. Researchers identified more than 26,000 adults with a smoking history across two major health systems and enrolled 1,333 who met Centers for Medicare & Medicaid Services (CMS) screening criteria. Participants were randomized to either receive the mPATH-Lung program or enhanced usual care.
Results showed that participants using mPATH-Lung were about 45% more likely to complete lung cancer screening than those in the control group (24.5% vs. 17.0%). Orders for screening CT scans were also higher (29.6% vs. 18.8%). Importantly, the intervention increased screening across racial, socioeconomic, and rural-urban groups—suggesting its potential to help reduce disparities in preventive care. Safety outcomes were reassuring, with low rates of false positives and no screening complications reported. Because control participants were told they qualified for screening and encouraged to talk to their doctor, the true effect of mPATH-Lung in typical care settings may be even greater than observed.
Relevance to Today’s mPATH Web App:
This study laid the foundation for the current web-based version of mPATH, which brings the same patient-centered features—education, test ordering, and follow-up—directly to patients’ devices at home. By enabling patients to engage and take action on their own time, mPATH continues to improve screening rates and reduce barriers to preventive care, including for those facing economic and literacy-related challenges.
Reference:
Miller DP, Snavely AC, Dharod A, et al. A Direct-to-Patient Digital Health Program for Lung Cancer Screening: A Randomized Clinical Trial. JAMA. Published online October 20, 2025.
Empowering Patients Doubles Screening Rates
Lessons from: “Effect of a Digital Health Intervention on Receipt of Colorectal Cancer Screening in Vulnerable Patients: A Randomized Controlled Trial”
Summary:
This randomized controlled trial evaluated the effectiveness of mPATH-CRC, a digital health intervention designed to increase colorectal cancer screening rates. Conducted in six community-based primary care practices, the study enrolled 450 patients who were overdue for screening. Participants were randomly assigned to either usual care or the mPATH-CRC intervention, which allowed patients to self-order screening tests and receive automated follow-up support.
The trial population faced significant barriers to care: half of participants had household incomes below $20,000 per year, and one-third had limited health literacy. Despite these challenges, 30% of patients using mPATH-CRC completed screening within 24 weeks, compared to just 15% in the usual care group. Intervention participants were also more likely to express a screening preference, engage in discussions with their providers, and have tests ordered. Over half (53%) self-ordered their screening tests, demonstrating the power of digital tools to activate patients and streamline preventive care.
Relevance to Today’s mPATH Web App:
This study laid the foundation for the current web-based version of mPATH, which brings the same patient-centered features—education, test ordering, and follow-up—directly to patients’ devices at home. By enabling patients to engage and take action on their own time, mPATH continues to improve screening rates and reduce barriers to preventive care, including for those facing economic and literacy-related challenges.
Reference:
Miller DP, Denizard-Thompson N, Weaver KE, Case LD, Troyer JL, Spangler JG, Pignone MP. Effect of a digital health intervention on receipt of colorectal cancer screening in vulnerable patients: a randomized clinical trial. Annals of Internal Medicine 2018;168(8):550-557.
Making Digital Tools Work in Real-World Clinics:
Summary:
This qualitative study explored the practical challenges and enablers of introducing an iPad-based decision aid for colorectal cancer screening in primary care settings. The tool helped identify eligible patients, educate them about screening options, and allowed them to request a test.
Through interviews and focus groups with 48 clinic staff, researchers identified key implementation factors—including time constraints, workflow disruptions, patient age, literacy challenges, and electronic health record (EHR) integration. Staff emphasized the importance of seamless workflow integration and ease of use for patients of all backgrounds.
Relevance to Today’s mPATH Web App:
This study informed the design of the current mPATH platform, which now operates outside the clinic setting. By delivering the app directly to patients at home via text or portal messages, mPATH avoids workflow disruptions and allows clinics to support informed decision-making without adding burden to staff.
Reference:
Puccinelli-Ortega N, Cromo M, Foley KL, Dignan MB, Dharod A, Snavely AC, Miller DP. Facilitators and Barriers to Implementing a Digital Informed Decision Making Tool in Primary Care: A Qualitative Study. Applied Clinical Informatics. 2022;13(1):1-9.
40% of Invited Patients Visit mPATH. Almost Everyone Completes It
Lessons from: “The Reach and Feasibility of an Interactive Lung Cancer Screening Decision Aid Delivered by Patient Portal”
Summary:
This study evaluated the reach and feasibility of delivering mPATH-Lung through patient portal outreach. Researchers sent a MyChart message to 1,000 randomly selected patients who may have been overdue for lung cancer screening. Over 400 patients (40%) visited mPATH™ in response, and 86% of those who visited completed the program.
These results demonstrate that patient portal outreach can be a highly effective way to engage patients in lung cancer screening decisions, with strong completion rates once patients access the program.
Relevance to Today’s mPATH Web App:
This study validated mPATH’s direct-to-patient delivery model. By using secure hyperlinks in text or portal messages, mPATH reaches patients where they are making it easy to engage with the program. High completion rates show that patients are willing and able to use mPATH when invited through familiar digital channels.
Reference:
Dharod A et al. The Reach and Feasibility of an Interactive Lung Cancer Screening Decision Aid Delivered by Patient Portal. Applied Clinical Informatics 2019. https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0038-1676807
The Electronic Health Record Misses Two-Thirds of People who Need Lung Screening. mPATH Finds them All.
Lessons from “A Comparison of Smoking History in Electronic Health Record With Self-Report”
Summary:
This study evaluated how well electronic health records (EHR) capture smoking history compared to patient self-report, with a focus on lung cancer screening eligibility. Researchers analyzed data from 336 adults aged 55–76 who used the mPATH-Lung WebApp.
While EHR data aligned closely with self-reported years of smoking and years since quitting, it significantly underestimated smoking intensity—such as pack-years and daily cigarette use. As a result, only 35% of patients deemed eligible by self-report met screening criteria based on EHR data alone, with many misclassified or missing key information.
Relevance to Today’s mPATH Web App:
This study highlights the value of collecting information directly from patients. The current mPATH-Lung platform uses a secure, web-based approach to gather detailed smoking history directly from patients—helping ensure accurate eligibility assessment and reducing missed opportunities for lung cancer screening.
Reference:
Patel N*, Miller DP, Snavely AC, Bellinger C, Foley KL, Case LD, McDonald ML, Masmoudi YR, Dharod A. A Comparison of Smoking History in the Electronic Health Record with Self-report. American Journal of Preventive Medicine. 2020;58(4):591-595.
Digital Tools That Work for Everyone: Usability of mPATH on iPad
Lessons from “Usability Of A Novel mHEALTH iPad Program By Health Disparate Populations”
Summary:
This study evaluated an early iPad-based version of mPATH designed to help patients make decisions about colorectal cancer screening. In a trial with 450 adults aged 50–74, 92% rated the program highly for ease of use—including those with limited reading skills or lower income. Only 6.9% needed help using the app, and needing assistance was not linked to background or education.
Relevance to Today’s mPATH Web App:
The current cloud-based version of mPATH builds on this foundation, offering the same user-friendly experience on patients’ own devices at home. By maintaining high usability across diverse populations, mPATH continues to support access to informed preventive care for all.
Reference:
Miller DP, Weaver KE, Case LD, Babcock D, Lawler D, Denizard-Thompson NR, Pignone MP, Spangler, JG. Usability of a novel mHealth iPad program by health disparate populations. JMIR mHealth and uHealth 2017;5(4):e43.
Why Personalization Matters in Lung Cancer Screening
Lessons from: “Lung Cancer Screening Benefits and Harms Stratified by Patient Risk: Information to Improve Patient Decision Aids”
Summary:
This study reanalyzed data from the National Lung Screening Trial (NLST) to provide individualized estimates of both the benefits and harms of lung cancer screening. Researchers examined outcomes for 53,452 high-risk individuals using the PLCOm2012 risk model to stratify results by patient risk level.
The analysis showed that while lung cancer screening can reduce mortality, the magnitude of benefit varies significantly by individual risk. Likewise, potential harms—such as false positives and invasive procedures—were more common among higher-risk individuals due to the increased prevalence of pulmonary nodules. The study emphasized the need for personalized decision aids that go beyond average-risk estimates to support more informed, patient-specific conversations.
Relevance to Today’s mPATH Web App:
These findings directly informed the design of mPATH-Lung, which incorporates individualized risk models to help patients understand both the potential benefits and harms of screening. By tailoring information to each person’s risk level, mPATH supports more meaningful decision-making and aligns with Medicare’s shared decision-making requirements.
Reference:
Bellinger CR*, Pinsky PF, Foley K, Case LD, Dharod A, Miller DP. Lung Cancer Screening Benefits and Harms Stratified by Patient Risk: Information to Improve Patient Decision Aids. Annals of the American Thoracic Society 2019;16(4):512-514.
Balancing Benefits and Harms in Lung Cancer Screening
Lessons from: “False Positive Screens and Lung Cancer Risk in the National Lung Screening Trial: Implications for Shared Decision-Making”
Summary:
This study explored how lung cancer risk influences the likelihood of false-positive results in low-dose computed tomography (LDCT) screening. Using data from the National Lung Screening Trial, researchers applied the Lung-RADS classification system to assess false-positive rates and the frequency of follow-up invasive procedures.
Findings revealed that false-positive rates increased with lung cancer risk, ranging from 12.9% to 25.9% across risk deciles. Similarly, invasive procedures following false positives were more common among higher-risk individuals, rising from 0.7% to 2.0%. These results underscore the importance of personalized decision-making tools that help patients understand both the potential benefits and harms of screening.
Relevance to Today’s mPATH Web App:
This research informed the development of mPATH-Lung, which incorporates individualized risk estimates to guide patients through the decision-making process. By helping users weigh the likelihood of benefit against the risk of harm, mPATH supports more informed and personalized choices about lung cancer screening.
Reference:
Pinsky PF, Bellinger CR, Miller DP. False positive screens and lung cancer risk in the National Lung Screening Trial: Implications for shared decision-making. Journal of Medical Screening 2018;25(2):110-112.
How Thoughtful Messaging Can Boost Screening Participation
Lessons from: “Crafting Appealing Text Messages to Encourage Colorectal Cancer Screening Test Completion: A Qualitative Study”
Summary:
This qualitative study explored how adults aged 50–75 respond to text message reminders for colorectal cancer screening. Through four focus groups, researchers examined participants’ attitudes toward screening, perceived barriers, and reactions to sample messages.
Key motivators included perceived health benefits and encouragement from family, while barriers ranged from discomfort and fear to lack of knowledge. Although participants were initially hesitant about receiving text reminders, they responded positively to messages that were clear, friendly, and reassuring—especially those that avoided medical jargon or alarming content.
Relevance to Today’s mPATH Web App:
This study helped shape mPATH’s communication strategy. Today, mPATH sends personalized, supportive messages via text or patient portal to invite users to engage with the app. These messages are crafted to be approachable and empowering, helping patients take the next step toward preventive care with confidence.
Reference:
Weaver KE, Ellis S, Denizard-Thompson N, Kronner D, Miller DP. Crafting Appealing Text Messages to Encourage Colorectal Cancer Screening Test Completion: A Qualitative Study. JMIR mHealth uHealth 2015;3(4):e100.
Bridging the Gap Between Guidelines and Practice
Lessons from: “Low-Dose CT Lung Cancer Screening Practices and Attitudes Among Primary Care Providers at an Academic Medical Center”
Summary:
This ground-breaking study was the first one to examine primary care providers’ knowledge, attitudes, and practices regarding low-dose computed tomography (LDCT) for lung cancer screening following the release of national guidelines. Conducted at an academic medical center, the survey assessed providers’ use of screening tests, familiarity with guidelines, perceived effectiveness, and barriers to adoption.
Findings revealed that LDCT was ordered infrequently (12%), while chest X-rays—despite not being recommended—were used more often (21%). Only 47% of providers were familiar with at least half of the guideline components, and 30% were unsure whether LDCT effectively reduced mortality. Barriers included cost concerns, false positives, patient awareness, incidental findings, and insurance issues. Providers also rated other cancer screening methods (e.g., mammography, colonoscopy) as more effective than LDCT.
Relevance to Today’s mPATH Web App:
This foundational study highlighted the need for tools that support guideline-based care and shared decision-making. mPATH-Lung helps address these gaps by educating patients directly and guiding them through personalized screening decisions—reducing reliance on provider familiarity alone and supporting more consistent use of evidence-based screening.
Reference:
Lewis JA, Petty WJ, Tooze JA, Miller DP, Chiles C, Miller AA, Bellinger C, Weaver KE. Low-dose CT Lung Cancer Screening Practices and Attitudes Among Primary Care Providers at an Academic Medical Center. Cancer Epidemiology, Biomarkers & Prevention. 2015;24(4):664-70.
Designing Digital Tools That Work for Everyone
Lessons from: “Health Literacy and Computer Assisted Instruction: Usability and Patient Preference”
Summary:
This randomized trial evaluated how patients with varying levels of health literacy interact with computer-assisted instruction, particularly in the context of colorectal cancer screening. Researchers studied 263 adults aged 50–74, assessing their ability to navigate two educational programs and their preferences for learning.
More than half of participants (56%) had limited health literacy, yet most were able to complete the digital program without assistance. Across literacy levels, doctors remained the most trusted source of medical information. Independent program completion was more likely among those with prior computer experience and health insurance. Notably, participants with limited literacy reported learning more from the digital tool than from a traditional brochure.
Relevance to Today’s mPATH Web App:
This study demonstrated that well-designed digital tools can be accessible and effective for patients regardless of literacy level. The current mPATH platform builds on these insights by offering a simple, intuitive interface that supports learning and decision-making for a broad range of users—helping ensure that no one is left behind in preventive care.
Reference:
Duren-Winfield V, Onsomu EO, Case LD, Pignone M, Miller DP. Health literacy and computer assisted instruction: usability and patient preference. Journal of Health Communication. 2015;20(4):491-8.
Engaging Patients Across Literacy Levels Through Digital Decision Aids
Lessons from: “Effectiveness of a Web-Based Colorectal Cancer Screening Patient Decision Aid: A Randomized Controlled Trial in a Mixed-Literacy Population”
Summary:
This randomized controlled trial evaluated a web-based decision aid designed to support colorectal cancer screening decisions among patients with varying levels of health literacy. Conducted in a socioeconomically disadvantaged population, the study included 264 participants and assessed whether the tool could improve screening readiness and test preference.
Participants who used the decision aid were significantly more likely to express a screening preference (84% vs. 55%) and report increased readiness to be screened (52% vs. 20%). While screening orders and completions were slightly higher in the decision-aid group, the differences were not statistically significant. Still, the tool clearly enhanced patient engagement and decision-making across literacy levels.
Relevance to Today’s mPATH Web App:
This study showed that education is a critical first step—it helps patients understand their options and increases their desire to be screened. But education alone isn’t enough. To meaningfully improve screening rates, patients also need system supports that make it easy to act on their decisions. The current mPATH platform combines education with action by allowing patients to request screening directly through the app and streamlining the entire process, turning informed intentions into completed screenings. demonstrated that digital tools can effectively support informed decision-making, even among patients with limited literacy. The current mPATH platform builds on this foundation by offering an accessible, web-based experience that helps patients understand their options and take action—regardless of background or education level.
Reference:
Miller DP, Spangler JG, Case LD, Goff DC, Singh S, Pignone MP. Effectiveness of a Web-Based Colorectal Cancer Screening Patient Decision Aid: A Randomized Controlled Trial in a Mixed-Literacy Population. American Journal of Preventive Medicine. 2011; 40(6):608-15.
Digital Education Can Match Traditional Counseling
Lessons from: “Using a Computer to Teach Patients About Fecal Occult Blood Screening: A Randomized Trial”
Summary:
This randomized trial evaluated whether a multimedia computer program could effectively educate patients about fecal occult blood testing (FOBT) and improve screening adherence. Conducted in a university-affiliated outpatient practice, the study enrolled 204 adults aged 50 and older who were offered FOBT screening.
Participants were randomized to either a computer-based educational session or standard nurse counseling. Screening completion rates were nearly identical between groups (62% for the computer group vs. 63% for the nurse group), with a slight trend toward greater knowledge mastery among those who used the computer-based tool. The study concluded that multimedia education can be just as effective as traditional counseling in supporting informed screening decisions.
Relevance to Today’s mPATH Web App:
This study demonstrated that digital education can match the effectiveness of in-person counseling, even for older adults. mPATH builds on this insight by offering a modern, web-based experience that not only educates patients but also enables them to take action—such as requesting screening—directly through the app, making preventive care more accessible and efficient.
Reference:
Miller DP, Kimberly JR, Case LD, Wofford JL. Using a Computer to Teach Patients about Fecal Occult Blood Screening: a randomized trial. Journal of General Internal Medicine 2005;20:984-8.
