Promoting Smoking Cessation in Lung Cancer Screening through Proactive Treatment

通过积极治疗促进肺癌筛查中的戒烟：PROACT VA医疗中心开始提供合格的退伍军人肺癌筛查后，国家 建议，包括美国预防服务工作组的“B”建议， 筛选VA肺癌筛查示范项目的初步证据表明， 近280万退伍军人将有资格接受筛查，超过一半的人将是目前的吸烟者， 吸烟史。至关重要的是，为目前的吸烟者提供筛查加强了以下方面的重要性： 停止，并不减少戒烟的动机。将戒烟纳入肺癌筛查， 具有挑战性，部分原因是时间和诊所资源有限，但也因为对 在许多吸烟者中，筛查的“保护”作用。在国家肺筛查试验中， 提供筛查的保健提供者充分解决了只有10%的当前吸烟者戒烟的问题。 该项目将为所有目前的吸烟者提供积极的行为和药物治疗， 参与肺癌筛查。烟草治疗将与筛查报告相结合 结果在我们的试点研究的积极电话咨询部分的建议干预，我们 在干预参与者中，将行为停止治疗的参与率从11%提高到36% 在常规护理对照组患者中，干预组的戒烟率增加了一倍多，达到18%。 筛查患者经常报告说，他们有动力参加筛查，以了解吸烟对健康的影响。 伤害了他们。我们提出的干预措施旨在将这种新的患者参与水平转化为 鼓励停止的机会。我们提出的积极主动的护理策略消除了要求的前提条件， 患者如果愿意放弃。超过14项试验表明，为所有当前吸烟者提供选择退出治疗 大大提高了戒烟率。 我们将在弗吉尼亚州普吉特湾和弗吉尼亚州纽约港对目前的吸烟者进行一项务实的随机试验， 正在参加肺癌筛查。患者将随机接受主动治疗， 伴随筛查结果的治疗（n=250）或常规护理（n=250）。积极治疗将是 由基于放射学的协调员安排，并将包括一个定制的结果信，描述 药物治疗，与患者的初级保健提供者一起订购的适当处方， 和两次主动电话行为咨询电话咨询部分将 由退伍军人事务部全国戒烟热线的顾问提供主要终点为经生化证实的7天 筛选后12个月禁欲。根据先前的选择退出治疗试验和我们的试点数据，该试验是 有能力检测到戒烟率从常规治疗的9%提高到选择退出治疗的至少18%。

Promoting smoking cessation in lung cancer screening through proactive therapy: PROACT VA Medical Centers are beginning to offer eligible Veterans lung cancer screening following national recommendations including the US Preventive Services Task Force's “B” recommendation for annual screening. Preliminary evidence from the VA Lung Cancer Screening Demonstration Project suggests that nearly 2.8 million Veterans will be eligible for screening and over half will be current smokers with a long history of smoking. It is critical that offering screening to current smokers reinforces the importance of cessation and does not reduce motivation to quit. Integrating cessation into lung cancer screening is challenging, in part because of limited time and clinic resources, but also because of misperceptions about the “protective” effect of screening among many current smokers. In the National Lung Screening Trial, primary care providers offering screening adequately addressed smoking cessation with only 10% of current smokers. This project will provide proactive behavioral and pharmacotherapy treatment to all current smokers as part of participating in lung cancer screening. Tobacco treatment will be integrated with the reporting of screening results. In our pilot study of the proactive telephone counseling component of the proposed intervention, we increased participation in behavioral cessation treatment to 36% among intervention participants from 11% among usual care control patients, and quit rates more than doubled to 18% in the intervention group. Screening patients often report being motivated to participate in screening to find out how much smoking has harmed them. Our proposed intervention is designed to convert this new level of patient engagement into an opportunity to encourage cessation. Our proposed proactive care strategy removes the precondition of asking patients if they are ready to quit. Over 14 trials have shown providing opt-out treatment to all current smokers significantly increases quit rates. We will conduct a pragmatic randomized trial with current smokers at VA Puget Sound and VA NY Harbor who are participating in lung cancer screening. Patients will be randomized to receive either proactive care with opt- out treatment accompanying their screening results (n=250) or usual care (n=250). Proactive treatment will be arranged by a radiology-based coordinator, and will include a tailored results letter describing pharmacotherapy, an appropriate prescription ordered in conjunction with the patient's primary care provider, and two proactive telephone-based behavioral counseling sessions. The telephone counseling component will be delivered by counselors at VA's national quitline. The primary endpoint is biochemically confirmed 7-day abstinence 12 months after screening. Based on prior trials of opt-out treatment and our pilot data, the trial is powered to detect an improvement in quit rates from 9% with usual care to at least 18% with opt-out treatment.