Integrating Evidence-Based Smoking Cessation Interventions into Lung Cancer Screening Programs: A Randomized Trial

将循证戒烟干预措施纳入肺癌筛查计划：随机试验

• 批准号: 10013675
• 负责人: Kathryn L Taylor
• 金额: $ 23.31万
• 依托单位: GEORGETOWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10013675
• 关键词: Abstinence; Address; Adherence; Adopted; Advisory Committees; Affect; Age; Appointment; Biochemical; Cancer Intervention and Surveillance Modeling Network; Cessation of life; Clinic; Communities; Cost Effectiveness Analysis; Counseling; Data; Disease; Early treatment; Enrollment; Future; Gender; Goals; Health; Individual; Insurance Carriers; Intervention; Life; Lung; Malignant neoplasm of lung; Mediator of activation protein; Methods; Modeling; Motivation; Nicotine Dependence; Outcome; Participant; Patient-Focused Outcomes; Persons; Policy Maker; Population; Preventive service; Primary Care Physician; Primary Health Care; Process Measure; Professional counselor; Protocols documentation; Public Health; Quality-Adjusted Life Years; Readiness; Risk; Screening Result; Site; Smoker; Smoking; Smoking Cessation Intervention; Societies; Specialist; Subgroup; Telephone; Testing; Tobacco; United States Centers for Medicare and Medicaid Services; arm; base; brief advice; computed tomography screening; cost; cost effective; design; economic evaluation; effective intervention; evidence base; experience; high risk; improved; intervention cost; lung basal segment; lung cancer screening; mortality; network models; novel; prevent; quitline; randomized trial; relative cost; screening; screening program; smoking cessation; treatment arm; treatment as usual; usual care arm

Lung cancer mortality can be reduced by 20% via CT screening and treatment of early stage disease. Maximum health impact from screening will only be achieved if high-risk smokers undergoing lung screening receive assistance to stop smoking. While there are several known effective cessation interventions, many of these are not scalable within diverse community-based lung cancer screening programs or with smokers who are not seeking cessation treatment. Our goal is to develop a scalable and cost-effective cessation intervention for widespread implementation to yield the greatest benefits and the lowest costs to both individuals and society. Guided by the RE-AIM Framework, we are proposing a pragmatic telephone counseling RCT, designed at the intersection of scalability and intensity, for future implementation within the national tobacco quitline. Our experienced team will conduct a randomized trial of 1330 smokers who have registered for screening at 5 diverse screening sites, comparing: 1) usual care (UC): participant-initiated (‘reactive’) telephone counseling (TC), in which smokers receive a referral to call in for the standard protocol of up to 8 counseling sessions and free NRT, vs. 2) a multi-faceted, 8-session, ‘proactive,’ counselor-initiated telephone counseling (CITC) protocol, tailored on screening result, with NRT provided at the screening exam, and with primary care engagement. Both arms receive brief advice to quit at the screening clinic, both English and Spanish speakers are included, and tobacco treatment specialists will conduct the TC. The goal of the CITC arm is to leverage the increased motivation provided by the teachable moment of lung screening and to counteract the potential for reduced motivation to quit following a normal result. Further, two important aspects of our approach include a cost-effectiveness analysis and use of the Cancer Intervention and Surveillance Modeling Network (CISNET) to evaluate the costs of the interventions relative to their impact on short- and long-term smoking-related outcomes. By including all smokers, regardless of readiness to quit, personalizing their tobacco-related health risks, and providing an evidence-based cessation intervention, we expect that the CITC arm will yield substantially higher quit rates with excellent potential for widespread implementation, resulting in a cost- effective intervention. The aims are: 1) To compare counselor-initiated telephone counseling (CITC) vs. usual care (UC) referral to standard telephone counseling, with biochemically verified 7-day, 30-day, and sustained abstinence. Intervention mediators and moderators will be assessed. 2) To evaluate reach and engagement of the interventions. 3) To conduct a cost-effectiveness analysis of CITC vs UC, in terms of cost per 6- and 12-month abstinence rates and quit attempts. The CISNET model will project the long-term impact of the interventions on cost per life year saved and quality-adjusted life years saved, lung cancer mortality reduction, and overall population mortality. This study will have a substantial public health impact by providing critical data to address scalability efforts by screening centers, insurers, and policy-makers.

通过CT筛查和早期疾病治疗，肺癌死亡率可降低20%。最大 只有在接受肺部筛查的高危吸烟者接受 帮助戒烟。虽然有几种已知的有效戒烟干预措施，但其中许多都是 在不同的基于社区的肺癌筛查项目中或在不吸烟的吸烟者中不可扩展 寻求戒烟治疗。我们的目标是开发一种可扩展且具有成本效益的戒烟干预措施， 广泛实施，为个人和社会带来最大的利益和最低的成本。 在RE-AIM框架的指导下，我们提出了一个务实的电话咨询RCT， 可扩展性和强度的交叉点，供未来在国家戒烟线内实施。我们 一个有经验的小组将对1330名登记在5岁时接受筛查的吸烟者进行随机试验。 不同的筛查地点，比较：1）常规护理（UC）：参与者发起的（“反应性”）电话咨询 (TC)，其中吸烟者收到转介，要求参加最多8次咨询会议的标准协议， 免费的NRT，与2）多方面的，8次会议，“积极主动”，顾问发起的电话咨询（CITC） 方案，根据筛选结果定制，在筛选检查时提供NRT，并提供初级护理 订婚两个手臂在筛查诊所接受简短的戒烟建议，讲英语和西班牙语 包括在内，烟草治疗专家将进行TC。CITC部门的目标是利用 肺部筛查的可教时刻提供了更大的动力， 在正常结果后戒烟的动机降低。此外，我们的方法的两个重要方面包括 成本效益分析和癌症干预和监测模型网络的使用 评估干预措施的成本相对于其对短期和长期吸烟相关的影响， 结果。通过包括所有吸烟者，无论是否准备戒烟，个性化他们与烟草相关的健康 风险，并提供基于证据的戒烟干预，我们预计CITC部门将产生 戒烟率显著提高，具有广泛实施的良好潜力，从而降低了成本- 有效干预。目的是：1）比较咨询师发起的电话咨询（CITC）与。 常规护理（UC）转诊至标准电话咨询，经生化验证7天、30天， 持续禁欲将评估干预调解员和主持人。2)评估覆盖范围， 参与干预。3)对CITC与UC进行成本效益分析， 6-以及12个月的戒烟率和戒烟尝试率。CISNET模式将预测以下方面的长期影响： 干预措施包括每挽救生命年成本、质量调整生命年挽救、肺癌死亡率 减少和总体人口死亡率。这项研究将对公共卫生产生重大影响， 提供关键数据，以解决筛查中心、保险公司和政策制定者的可扩展性工作。

项目成果

Development and Evaluation of Brief Web-Based Education for Primary Care Providers to Address Inequities in Lung Cancer Screening and Smoking Cessation Treatment.

为初级保健提供者开发和评估简短的网络教育，以解决肺癌筛查和戒烟治疗中的不平等问题。

• DOI: 10.1007/s13187-023-02262-3
• 发表时间: 2023
• 期刊: Journal of cancer education : the official journal of the American Association for Cancer Education
• 作者: Smith,Laney;Williams,RandiM;Whealan,Julia;Windels,Allison;Anderson,EricD;Parikh,Vicky;Breece,ChavaliaJoan;Puran,Namita;Shepherd,AndreaK;Geronimo,Maria;Luta,George;Adams-Campbell,Lucile;Taylor,KathrynL
• 通讯作者: Taylor,KathrynL

Improved motivation and readiness to quit shortly after lung cancer screening: Evidence for a teachable moment.

• DOI: 10.1002/cncr.34133
• 发表时间: 2022-05-15
• 期刊: CANCER
• 影响因子: 6.2
• 作者: Williams, Randi M.;Cordon, Marisa;Eyestone, Ellie;Smith, Laney;Luta, George;McKee, Brady J.;Regis, Shawn M.;Abrams, David B.;Niaura, Raymond S.;Stanton, Cassandra A.;Parikh, Vicky;Taylor, Kathryn L.
• 通讯作者: Taylor, Kathryn L.

Predictors of attrition in a smoking cessation trial conducted in the lung cancer screening setting.

• DOI: 10.1016/j.cct.2021.106429
• 发表时间: 2021-07
• 期刊: Contemporary clinical trials
• 影响因子: 2.2
• 作者: Kim E;Williams RM;Eyestone E;Cordon M;Smith L;Davis K;Luta G;Anderson ED;McKee B;Batlle J;Ramsaier M;Howell J;Parikh V;Geronimo M;Stanton C;Niaura R;Abrams D;Taylor KL;Lung Screening, Tobacco and Health Trial
• 通讯作者: Lung Screening, Tobacco and Health Trial

Correction to: Development of Decisional Values Statements for Lung Cancer Screening among African American Smokers.

更正：非洲裔美国吸烟者肺癌筛查决策价值声明的制定。

• DOI: 10.1007/s13187-020-01693-6
• 发表时间: 2020
• 期刊: Journal of cancer education : the official journal of the American Association for Cancer Education
• 作者: Williams,RandiM;Beck,KennethH;Butler3rd,James;Lee,Sunmin;Wang,MinQi;Taylor,KathrynL;Knott,CherylL
• 通讯作者: Knott,CherylL

Lung cancer screening decisional needs among African American smokers of lower socioeconomic status.

• DOI: 10.1080/13557858.2020.1771681
• 发表时间: 2022-04
• 期刊: Ethnicity & health
• 影响因子: 3.1
• 作者: Williams RM;Beck KH;Butler J 3rd;Lee S;Wang MQ;Taylor KL;Knott CL
• 通讯作者: Knott CL