Integrating Smoking Cessation with Lung Cancer Screening

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 DESCRIPTION (provided by applicant): Lung cancer screening with low-dose computed tomography chest (CT) imaging among current smokers may be a valuable opportunity to engage in discussions about individualized risks associated with smoking, and help motivate smokers to consider exploring available tobacco cessation resources including the VA Quit Line. Time constraints make it challenging to have in depth discussions during clinic visits, and mailed test results and written patient education materials may not be adequate to comprehensively address tobacco cessation. This pilot study will test a prototype tele-nurse intervention that consists of two contacts. A nurse will call patients after they are referred for screening, but prior to undergoing screening, to review any additional questions patients may have about the screening process. Second, the nurse will contact patients to review the results of the screening test. The prototype intervention will be tested in 28 patients who are offered screening as part of VA's Lung Cancer Screening Clinical Demonstration Project (Aim 1). Patients from two sites - NY Harbor and Portland VA Medical Centers - will be approached remotely by a tele-nurse based in the Seattle COIN. The intervention sessions will incorporate evidence-based motivational interviewing techniques guided by the parallel process model which motivates health behavior actions through helping individuals understand their individual susceptibility and strengthen motivation and self-efficacy. An assessment call will be conducted four weeks after the second intervention session in order to assess utilization of the VA Quit Line and other tobacco cessation resources. A convenient sample of 28 subjects, also offered lung cancer screening as part of the Demonstration Project, will be contacted for a single assessment call to measure utilization of tobacco cessation resources and smoking behaviors in the absence of the intervention (Aim 2). We will qualitatively review the transcripts from the intervention sessions to identify key messages that motivate participants to use cessation resources, and explore for potential differences in receptivity to the intervention by race and literacy (Aim 3). Our goal is to refine the interventio to ensure we target vulnerable Veteran smokers with low health literacy who may underestimate their individual health risks associated with smoking as a result of being offered lung cancer screening. Findings from this study will inform a larger intervention trial testing telephone-based counseling integrated into lung cancer screening, with the goal of increasing quit rates through promoting the use of the VA Quit Line and tobacco cessation tools.