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Assessing the integration of tobacco cessation treatment into lung cancer screening

评估戒烟治疗与肺癌筛查的整合

基本信息

批准号：
10117200
负责人：
JENNIFER S HAAS
金额：
$ 74.46万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-04-16 至 2023-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10117200
关键词：
Abstinence Address Adherence Adopted Adoption Advisory Committees Age Biochemical Caring Cessation of life Characteristics Chronic Disease Common Data Element Communities Counseling Coupled Databases Development Disease Management Dose Enrollment Evaluation Fibrinogen Guidelines Health system Healthcare Systems Hour Individual Informal Social Control Integrated Delivery of Health Care Integrated Health Care Systems Intervention Language Link Lung Maintenance Malignant Neoplasms Malignant neoplasm of lung Medical Medicare Methods Modeling Morbidity - disease rate Motivation Nicotine Dependence Outcome Participant Patient Self-Report Patients Pharmacology Pharmacotherapy Population Prevalence Preventive service Process Measure Program Sustainability Provider Psychosocial Assessment and Care Radiology Specialty Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Readiness Reporting Resources Scanning Schedule Screening Result Series Services Site Smoker Smoking Smoking Cessation Intervention Smoking History Specialist System Technology Telephone Test Result Testing Time Tobacco Tobacco Use Cessation Training United States Videoconferencing Work base care coordination compare effectiveness cost cost effectiveness design effective intervention effective therapy effectiveness evaluation effectiveness implementation design effectiveness implementation study evidence base experience follow-up group intervention health belief health care delivery health care settings health information technology high risk low dose computed tomography lung cancer screening meetings mortality multidisciplinary nicotine replacement novel optimal treatments outreach patient engagement patient outreach patient population patient portal performance tests personalized intervention practice setting primary outcome programs randomized trial risk perception routine screening screening smoking cessation social social culture sociodemographic factors sociodemographics telehealth tobacco abstinence tobacco cessation intervention tool treatment program treatment services treatment strategy trial design

项目摘要

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.

摘要