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%。国家肺筛查试验表明， 低剂量计算机断层扫描（LDCT）肺癌筛查（LCS）可降低肺癌死亡率。 指南建议向高风险老年人提供年度LCS并伴有戒烟治疗 个体支付者为高风险个人支付LCS，而Medicare要求LCS站点提供吸烟服务 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， 在可教的时刻向吸烟者提供戒烟治疗。然而，最佳治疗策略 这些长期的，高度依赖的吸烟者接受LCS尚未确定， 将烟草治疗服务纳入高容量放射学实践的挑战。 我们提出了一种混合 有效性实施设计，以检查开发，整合和实施一个新的， 个性化，英语和西班牙语，循证戒烟干预到LCS网站， 由两个网络组成的大型、多样化、综合的卫生保健提供系统。 最大限度地扩大 烟草治疗，吸烟者将在最多3个时间点（LCS）获得个性化帮助和外展服务 测试顺序、扫描和结果）。我们会利用崭新的医疗资讯科技平台， 患者外展和访问，使用患者门户网站、信息视频（Vidscrip）和视频等技术， 会议。在健康信念和自我调节模式的指导下进行慢性病管理 从这个角度来看，多组分的LCS定制干预措施针对的是老年人，长期，重度吸烟者， 将进行LCS。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、戒烟准备情况和LCS结果进行个性化设置;系统性筛查， 转介社区资源，以解决戒烟的社会障碍。烟草集中处理 专家将通过一系列积极的激励性电话或视频会议提供干预， 以维持患者的参与。采用析因设计的随机试验将测试3种干预措施 不同的组成部分（1）咨询持续时间，（2）NRT剂量，（3）系统筛查和转诊 在6个筛查点接受LCS的960名当前吸烟者的戒烟社会障碍。主 结果是生物化学验证的6个月时的7天时点戒烟率。探索性 分析将确定患者和LCS水平的因素，调节干预组之间的关系， 和吸烟结果，包括社会人口统计学特征、医疗和吸烟特征，以及 LCS相关因素（即，LCS结果，研究入组时间点）。在RE-AIM框架的指导下，我们将 进行 严格混合方法评价 干预的范围、采用和实施 （包括成本效益） 从提供者、付款人和患者的角度）， 和维护 我们 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 LCS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.