Assessing the integration of tobacco cessation treatment into lung cancer screening

摘要 肺癌占美国癌症死亡人数的27%。全国肺部筛查试验表明， 使用低剂量计算机断层扫描(LDCT)的肺癌筛查(LCS)可降低肺癌死亡率。 指南建议每年向高危老年人提供LCS并进行戒烟治疗 个人。付款人为高危个人提供LCS保险，而Medicare要求LCS网站提供吸烟 现在的吸烟者戒烟。采用LCS的医疗保健系统有一个关键的新机会来提供 在可教的时刻向吸烟者提供戒烟治疗。然而，一种最佳的治疗策略 这些接受LCS治疗的长期、高度依赖的吸烟者尚未确定，而且有 将烟草治疗服务整合到大容量放射学实践中的挑战。 我们提出了一种混合动力 有效性-实施设计，以检查开发、集成和实施一种 对LCS网站进行个性化、英语和西班牙语的循证戒烟干预 一个由两个网络组成的大型、多样化、综合的医疗保健提供系统。 最大限度地扩大……的影响范围 在烟草治疗方面，吸烟者将在最多3个时间点(LCS)获得个性化的帮助和外展 测试顺序、扫描和结果)。我们会利用新的医疗资讯科技平台推广 患者外展和访问，使用患者门户、信息视频(Vidcrip)和视频等技术 会议。以健康信念和自我调节模式为导向的慢性病管理 从角度来看，多组分LCS量身定做的干预措施针对的是年龄较大、长期吸烟的重度吸烟者 将接受腰椎管综合征。它提供咨询支持和药物治疗(尼古丁替代疗法[NRT])； 根据吸烟者的风险认知、戒烟准备和LCS结果进行个性化；以及系统的筛查和 转介到社区资源，以解决戒烟的社会障碍。集中的烟草治疗 专家将通过一系列积极的励志电话或视频会议进行干预- 以会议为基础，以维持患者的参与度。采用析因设计的随机试验将测试3种干预措施 根据(1)咨询持续时间、(2)NRT剂量和(3)系统筛查和转诊的不同而不同的组成部分 在6个筛查点接受LCS的960名当前吸烟者中戒烟的社会障碍。初级阶段 结果是生化验证的7天点流行烟草戒烟率为6个月。探索性的 分析将确定患者和LCS水平的因素，以调节干预组之间的关系 和吸烟结果，包括社会人口学特征、医疗和吸烟特征，以及 LCS相关因素(即LCS结果、进入研究的时间点)。在RE-AIM框架指导下，我们将 开展一项 严格的混合方法评估 干预的影响范围、采用、实施情况 (包括成本效益 从提供者、付款人和患者的角度)， 和维护。 我们的 该计划可以为全国卫生系统提供一个可持续的模式，将烟草治疗纳入 腰椎管综合征筛查。

Abstract Lung cancer accounts for 27% of U.S. cancer deaths. The National Lung Screening Trial demonstrated that lung cancer screening (LCS) with low-dose computed tomography (LDCT) reduces lung cancer mortality. Guidelines recommend offering annual LCS accompanied by smoking cessation treatment to high-risk, older individuals. Payers cover LCS for high-risk individuals, and Medicare requires LCS sites to offer smoking cessation to current smokers. Health care systems adopting LCS have a critical new opportunity to deliver tobacco cessation treatment to smokers at a teachable moment. However, an optimal treatment strategy for these long-term, highly dependent smokers undergoing LCS has not yet been determined, and there are challenges to integrating tobacco treatment services into high-volume radiology practices. We propose a hybrid effectiveness-implementation design to examine the development, integration, and implementation of a novel, personalized, English and Spanish language, evidence-based smoking cessation intervention into LCS sites in a large, diverse, integrated health care delivery system, comprised of two networks. To maximize the reach of tobacco treatment, smokers will be offered personalized assistance and outreach at up to 3 time points (LCS test order, scan, and results). We will utilize novel health information technology (IT) platforms to promote patient outreach and access, using technologies like patient portals, informational videos (Vidscrip), and video- conferencing. Guided by the Health Belief and Self Regulation models with a chronic disease management perspective, the multi-component LCS-tailored intervention targets the older, long-term, heavy smokers who will undergo LCS. It provides counseling support and pharmacotherapy (nicotine replacement therapy [NRT]); is personalized to smokers' risk perceptions, readiness to quit, and LCS results; and systematic screening and referral to community-based resources to address social barriers to quitting. A centralized tobacco treatment specialist will deliver the intervention in a series of proactive motivational telephone- or videoconferencing- based sessions to sustain patient engagement. A randomized trial with a factorial design will test 3 intervention components that vary by (1) counseling duration, (2) NRT dose, and (3) systematic screening and referral for social barriers to quitting among 960 current smokers undergoing LCS at 6 screening sites. The primary outcome is biochemically-validated 7-day point-prevalence tobacco abstinence rates at 6 months. Exploratory analyses will identify patient- and LCS-level factors that moderate the relationship between intervention group and smoking outcomes, including socio-demographic characteristics, medical and smoking characteristics, and LCS-related factors (i.e., LCS result, time point of study entry). Guided by the RE-AIM framework, we will conduct a rigorous mixed methods evaluation of the intervention's reach, adoption, implementation (including cost-effectiveness from provider, payer and patient perspectives), and maintenance. Our program could provide health systems nationally with a sustainable model to integrate tobacco treatment into LCS screening.