Optimizing Effectiveness of Smoking Cessation Intervention During LDCT screening for Lung Cancer

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PROJECT SUMMARY The low-dose computed tomography (LDCT) lung cancer screening environment may provide a unique opportunity to deliver evidence-based smoking cessation treatments at a time where smokers' interest in health concerns may make them particularly receptive to a quitting message. While there are well established methods for smoking cessation in the general community, the optimal configuration of a smoking cessation intervention in a real-world lung cancer screening setting has not been established. It seems clear that such interventions should go beyond the provision of passively providing smoking cessation advice, but the intervention modality, level of intensity and degree of integration with the screening setting is unknown. Despite enthusiasm for integrating smoking cessation programs within health care settings there have been few attempts to actually develop such programs. The proposed research will be among the first to focus on identifying the optimal configuration for integrating a program into the LDCT for lung cancer screening. This study will also ascertain the cost-effectiveness and value of implementation of increasingly more integrative and intensive strategies. This will enable decision makers and other stakeholders to assemble a cessation program that provides maximum effectiveness while considering resource allocation efficiency within their LDCT screening environment. The present proposal focuses on the relative effectiveness and cost of three major components of a smoking cessation intervention: a publically available cessation quitline; level of involvement of LDCT medical providers; and integration of smoking cessation specialists within the LDCT setting. Smokers (N=630) will be randomly assigned to three groups: Quitline (QL); Quitline-Rx (QL-Rx); and Integrated Care (IC). The QL intervention is intended to model the real-world situation in which smokers who present for lung cancer screening are provided standard care (brief advice for smoking cessation) and referred to the quitline for smoking cessation counseling and nicotine replacement therapy. The Quitline-Rx group is intended to model an environment in which the LDCT medical provider assumes an active role in selecting and managing available pharmacotherapy for smoking cessation, and the quitline serves as the provider for smoking cessation counseling. The Integrated Care intervention (IC) presents the highest level of care and is models an environment in which smoking cessation counseling and medication management are provide by smoking cessation specialists within that setting. The major contribution of this research is expected to be a change in clinical practice and advancing a model for providing integrated smoking cessation treatment as a “gold” standard for LDCT lung cancer screening settings across the country. Ultimately the availability of smoking cessation services will enhance the impact of lung cancer screening on the public health by reducing smoking related illness.