Optimizing Tobacco Treatment for Smokers Seeking Lung Cancer Screening

项目摘要 有一个及时和迫切需要了解和利用肺癌筛查的背景下，提供 戒烟治疗和促进戒烟的个人在高风险的肺和其他吸烟- 相关疾病。长期目标是最大限度地提高肺癌筛查的公共卫生效益， 为肺癌患者提供整合和维持烟草治疗的最佳实践蓝图 筛选设置。当前项目将通过确定上级和可扩展的 与寻求筛查的当前吸烟者相关的烟草治疗成分， 通过异质性肺癌筛查位点以高实现保真度有效地递送。的 拟议的研究将使用一个创新的方法框架，多阶段优化策略 （MOST），设计一个优化的，可扩展的循证烟草治疗包，可以很容易地 整合到肺癌筛查网站中。MOST涉及高效的随机实验， 精确量化单个治疗成分的效果，并通过组合 将其转化为有效的烟草治疗包。然后，该信息指导优化的 治疗包，以最少的资源消耗和工作人员负担达到目标结果。的 拟议研究的基本原理是，一旦建立了优化的烟草处理包，未来 比较有效性试验可以检查在LDCT中更广泛实施和传播的战略， LCS设置。与肺癌联盟及其国家卓越框架合作， 肺癌筛查，我们将在美国各地确定18个异质性肺癌筛查点。 将作为实地示范点的各州。将从18名吸烟者中招募60名吸烟者。 参与筛选研究中心（n= 1，080）。研究结果将指导组装优化和可扩展的 实现上级戒烟结果的戒烟治疗包，注意最小化 肺癌筛查网站。本研究将应用MOST来实现以下目标：目标1：使用高度 有效的社会变革管理计划，以确定正在考虑的四个循证烟草治疗组成部分中的哪一个 有助于达到上级戒烟终点。待测试的四种烟草处理组分是：（1） 动机访谈（MI）（是与否）;（2）NRT贴片（是与否）; 3）NRT含片（是与否）;和4） 信息框架（得失）;目标2：估计证据的成本和增量成本效益- 目标3：以成熟的烟草处理成分为指导， 评估和概念实施科学框架，我们将进行一个强大的，混合的方法， 评价执行进程并评估可能影响执行的因素， 提供和传播肺癌戒烟治疗有效模式的可持续性 筛选设置。

PROJECT SUMMARY There is a timely and urgent need to understand and leverage the context of lung cancer screening to deliver smoking cessation treatment and promote cessation among individuals at high risk for lung and other smoking- related diseases. The long-term goal is to maximize the public health benefits of lung cancer screening by providing a blueprint of best practices for integrating and sustaining tobacco treatment delivery in lung cancer screening settings. The current project will make a vital contribution by identifying superior and scalable tobacco treatment components with relevance for current smokers seeking screening that can be cost- effectively delivered with high implementation fidelity by heterogeneous lung cancer screening sites. The proposed research will use an innovative methodological framework, the Multiphase Optimization Strategy (MOST), to design an optimized, scalable evidence-based tobacco treatment package that can be readily integrated within lung cancer screening sites. MOST involves highly efficient, randomized experimentation to precisely quantify the effects of individual treatment components and identify synergistic effects by combining them into an effective tobacco treatment package. This information then guides assembly of an optimized treatment package that achieves target outcomes with minimal resource consumption and staff burden. The rationale for the proposed research is that once an optimized tobacco treatment package is established, future comparative effectiveness trials can examine strategies for wider implementation and dissemination in LDCT- LCS settings. In partnership with the Lung Cancer Alliance and their National Framework for Excellence in Lung Cancer Screening, we will identify 18 heterogeneous lung cancer screening sites across the United States that will serve as demonstration field sites. Sixty current smokers will be recruited from each of the 18 participating screening sites (n=1,080). The findings will guide assembly of an optimized and scalable cessation treatment package that achieves superior cessation outcomes with attention to minimizing burden in lung cancer screening sites. This study will apply MOST to achieve the following aims: Aim 1: To use a highly efficient MOST to identify which of four evidence-based tobacco treatment components under consideration contribute to superior cessation endpoints. The four tobacco treatment components to be tested are: (1) Motivational Interviewing (MI) (Yes vs. No); (2) NRT Patch (Yes vs. No); 3) NRT Lozenge (Yes vs No); and 4) Message Framing (Gain vs Loss); Aim 2: To estimate the cost and incremental cost-effectiveness of evidence- based tobacco treatment components, delivered alone and in combination; Aim 3: Guided by well-established evaluation and conceptual implementation science frameworks, we will conduct a robust, mixed methods evaluation of the implementation process and assess factors that may influence implementation and sustainability for delivering and disseminating effective models for smoking cessation treatment in lung cancer screening settings.