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

项目摘要 低剂量计算机断层扫描（LDCT）肺癌筛查环境可能提供独特的 在吸烟者对健康感兴趣的时候提供循证戒烟治疗的机会 担忧可能使他们特别容易接受辞职的信息。虽然有一些已经建立的 戒烟方法在一般社会中，戒烟的最佳配置 在现实世界的肺癌筛查环境中的干预尚未建立。显然，这样的 干预措施应超越被动提供戒烟建议的规定，但 干预方式、强度水平和与筛查环境的整合程度尚不清楚。 尽管人们热衷于将戒烟计划纳入医疗保健环境， 实际上是在开发这样的项目。这项拟议中的研究将是第一批关注 识别用于将程序整合到用于肺癌筛查的LDCT中的最佳配置。这 研究还将确定实施日益一体化的 强化战略。这将使决策者和其他利益相关者能够聚集一个停止 提供最大效率的计划，同时考虑其内部的资源分配效率 LDCT筛查环境。本建议侧重于三个方面的相对有效性和成本 戒烟干预的主要组成部分：可获得的戒烟热线; LDCT医疗提供者的参与;以及LDCT内戒烟专家的整合 设置.吸烟者（N=630）将被随机分配到三组：Quitline（QL）; Quitline-Rx（QL-Rx）;和 综合护理（IC）。QL干预旨在模拟吸烟者的真实情况， 为参加肺癌筛查的人提供标准护理（戒烟的简短建议）， 戒烟咨询和尼古丁替代疗法。Quitline-Rx 小组旨在模拟一种环境，在这种环境中，LDCT医疗提供者在以下方面发挥积极作用： 选择和管理可用的戒烟药物治疗，戒烟热线作为 提供戒烟咨询。综合护理干预（IC）提供了最高水平的 护理和模型的环境中，戒烟咨询和药物管理是 由戒烟专家在该环境中提供。这项研究的主要贡献是 预计将成为临床实践的一个变化，并推进提供综合戒烟的模式 作为全国LDCT肺癌筛查设置的“金”标准。最终 提供戒烟服务将加强肺癌筛查对公众健康的影响 减少与吸烟有关的疾病。

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.