Optimizing Tobacco Treatment for Smokers Seeking Lung Cancer Screening

项目总结 及时而迫切地需要了解和利用肺癌筛查的背景来提供 戒烟治疗并在肺部和其他吸烟的高危人群中促进戒烟- 相关疾病。我们的长远目标是通过以下方式，最大限度地提高肺癌筛查的公众健康效益 为整合和维持肺癌的烟草治疗提供最佳做法的蓝图 筛选设置。当前的项目将通过确定卓越的和可扩展的 烟草治疗成分与寻求筛查的当前吸烟者相关，可能成本较高- 通过异质肺癌筛查站点以高实施保真度有效地提供。这个 拟议的研究将使用一种创新的方法框架--多阶段优化战略 (MOST)，设计一种优化的、可扩展的循证烟草治疗方案，它可以很容易地 整合到肺癌筛查网站中。MOST涉及高效、随机的实验，以 精确量化个别治疗成分的效果，并通过组合确定协同效应 将它们整合成有效的烟草治疗方案。然后，此信息将指导优化的 以最小的资源消耗和工作人员负担实现目标结果的一揽子治疗方案。这个 拟议研究的理由是，一旦建立了优化的烟草处理一揽子计划，未来 比较有效性试验可以审查在最不发达国家工作队中更广泛地实施和传播的战略-- 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个不同类型的肺癌筛查地点 将作为示范现场的州。将从18名吸烟者中各招募60名目前吸烟者 参与筛查地点(n=1,080)。这些发现将指导优化和可扩展的 戒烟治疗包，实现卓越的戒烟效果，并注意将负担降至最低 肺癌筛查网站。这项研究将最大限度地实现以下目标：目标1：使用高度的 最有效地确定正在考虑的四种循证烟草治疗成分中的哪一种 为更好的戒烟终点做出贡献。待检测的四种烟草处理成分是：(1) 激励性面试(MI)(是与否)；(2)NRT贴片(是与否)；3)NRT含片(是与否)；以及4) 信息框架(收益与损失)；目标2：估计证据的成本和增量成本效益-- 以烟草处理成分为基础，单独和组合提供；目标3：由公认的指导 评估和概念实施科学框架，我们将进行稳健、混合的方法 评价执行进程并评估可能影响执行的因素和 传递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.