Attitudes and Perceptions About Smoking Cessation in the Context of Lung Cancer Screening
Attitudes and Perceptions About Smoking Cessation in the Context of Lung Cancer Screening
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DOI：
10.1001/jamainternmed.2015.3558
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发表时间：
2015-09-01
影响因子：
39
通讯作者：
Au, David H.
中科院分区：
文献类型：
--
作者：
Zeliadt, Steven B.;Heffner, Jaimee L.;Au, David H.
重要信息广泛采用肺癌筛查可能会无意中导致负面的人群健康结果，如果它被视为戒烟的替代品。目的了解在初级保健中作为常规服务提供肺癌筛查的背景下，当前吸烟者对戒烟的看法。设计，设置和参与者作为一项辅助研究，在退伍军人健康管理局的7个地点启动肺癌筛查项目，于5月29日至9月22日对45名与吸烟和肺癌筛查相关的健康信念进行了深入的半结构化定性访谈，2014年，通过电话向37名当前吸烟者提供了由其初级保健医生进行的肺癌筛查。分析时间为2014年6月15日至2015年3月29日。主要结果和测量在肺癌筛查背景下戒烟的重要性的态度和看法。肺癌筛查促使大多数目前的吸烟者第一次反思吸烟对他们目前和未来的健康意味着什么。然而，35名参与者中有17名（49%）描述了筛查降低其戒烟动机的机制，包括接受成像测试产生与戒烟相同的健康益处的看法。其他误解包括认为每个参与筛查的人都会受益;认为筛查和能够返回进行额外筛查可以保护肺癌;一些人认为筛查的结果挽救了他们的生命，因为当发现不确定的发现时，可以监测而不是立即治疗，可以早期发现癌症;并且一些人更加相信，无癌症筛查结果表明他们是能够避免吸烟危害的幸运儿之一。结论和相关性在这一定性研究中，肺癌筛查促使许多目前的吸烟者反思他们的健康状况，并可能成为让患者参与讨论的潜在机会关于戒烟。然而，确定了几个有关的途径，其中筛选，当作为常规护理的一部分提供时，并被描述为具有已证实的疗效，可能会对戒烟产生负面影响。卫生保健专业人员应该意识到，早期发现肺癌的机会可能被解释为避免吸烟危害的一种方式。为了促进戒烟，讨论应该集中在对筛查的情绪反应上，而不是临床细节（如结节大小），并解决对早期发现价值的误解，以便筛查不会降低戒烟的动机。
IMPORTANCEBroad adoption of lung cancer screeningmay inadvertently lead to negative population health outcomes if it is perceived as a substitute for smoking cessation. OBJECTIVE To understand views on smoking cessation from current smokers in the context of being offered lung cancer screening as a routine service in primary care.DESIGN, SETTING, AND PARTICIPANTSAs an ancillary study to the launch of a lung cancer screening program at 7 sites in the Veterans Health Administration, 45 in-depth semi-structured qualitative interviews about health beliefs related to smoking and lung cancer screening were administered from May 29 to September 22, 2014, by telephone to 37 current smokers offered lung cancer screening by their primary care physician. Analysis was conducted from June 15, 2014, to March 29, 2015.MAIN OUTCOMES AND MEASURESAttitudes and perceptions about the importance of smoking cessation in the context of lung cancer screening.RESULTSLung cancer screening prompted most current smokers to reflect for the first time on what smoking means for their current and future health. However, 17 of 35 (49%) participants described mechanisms whereby screening lowered their motivation for cessation, including the perception that undergoing an imaging test yields the same health benefits as smoking cessation. Other misperceptions include the belief that everyone who participates in screening will benefit; the belief that screening and being able to return for additional screening offers protection from lung cancer; the perception by some individuals that findings from screenings have saved their lives by catching their cancer early when indeterminate findings are identified that can be monitored rather than immediately treated; and a reinforced belief in some individuals that a cancer-free screening test result indicates that they are among the lucky ones who will avoid the harms of smoking.CONCLUSIONS AND RELEVANCEIn this qualitative, lung cancer screening prompted many current smokers to reflect on their health and may serve as a potential opportunity to engage patients in discussions about smoking cessation. However, several concerning pathways were identified in which screening, when offered as part of routine care and described as having proven efficacy, may negatively influence smoking cessation. Health care professionals should be aware that the opportunity for early detection of lung cancer may be interpreted as a way of avoiding the harms of smoking. To promote cessation, discussions should focus on the emotional response to screening rather than clinical details (eg, nodule size) and address misperceptions about the value of early detection so that screening does not lower motivation to quit smoking.