Precision prevention strategy to increase uptake and engagement in lung cancer screening and smoking cessation treatment

项目总结/摘要 肺癌是最致命的一种癌症，80%以上的肺癌和肺癌死亡病例是由 吸烟引起的。每年进行一次低剂量计算机断层扫描进行肺癌筛查， 推荐用于长期吸烟者和既往吸烟者，但仅占760万合格患者的2% 接受肺癌筛查。这些患者中的大多数是目前的吸烟者，但很少有人接受有效的烟草 治疗，非洲裔美国人之间的护理差距甚至更大。这个问题需要解决， 多个层面，因为肺癌筛查和烟草治疗的采用都是由医生的命令驱动的 患者接受护理。针对医生和患者的新颖，个性化的努力可能会提高 肺癌筛查和烟草治疗。我们提出了一个多层次的干预具有精度风险 旨在通过激励行为改变和促进患者 初级保健医生和医疗服务不足的肺部风险患者之间的集中讨论 癌这项创新的动机是两个关键的发现：1）临床和遗传因素告知精确风险， 肺癌和戒烟，2）对个人遗传风险反馈的高度渴望表明其潜力 to activate激活behavior行为change更改.基于重要的基因组学进展，我们的团队开发了RiskProfile， 一个面向医生和患者的工具，可以将遗传风险反馈纳入其中，以促进循证护理 和降低癌症风险的行为。这项研究的首要目标是测试风险概况的影响， 无论是否有遗传信息，与常规护理相比，对肺癌筛查的摄取 烟草治疗我们提出了一个3臂集群随机对照试验的75名医生和825 筛选合格的患者（每名医生11名），来自不同的初级保健环境。医生和病人将 随机分配至常规治疗vs RiskProfile-Clin（基于临床因素）vs RiskProfile-Gen（基于临床因素） 和遗传因素），以评估精确风险干预对肺癌筛查和烟草的影响。 治疗在目标1和2中，我们将测试RiskProfile对医嘱和患者完成 肺癌筛查和烟草治疗。我们预测RiskProfile-Gen的表现将优于RiskProfile-Clin， 两组患者的表现都优于常规治疗。主要结局将是肺的排序和完成 在符合筛查条件的患者中进行癌症筛查。次要结果将是订购和接收烟草 对符合筛查条件的吸烟者进行治疗。在目标3中，我们将探讨风险概况对 行为改变的潜在机制（医生感知、患者认知或参与因素，以及 医患互动），这可能会增加肺癌筛查和烟草治疗的吸收。通过 以医生和患者为目标，同时解决癌症筛查和戒烟护理问题， 风险反馈工具有可能降低服务不足人群的肺癌发病率和死亡率。

PROJECT SUMMARY/ABSTRACT Lung cancer is the deadliest form of cancer, and more than 80% of lung cancers and lung cancer deaths are caused by cigarette smoking. Lung cancer screening with annual low‐dose computed tomography is recommended for long‐term current and former smokers, yet as few as 2% of 7.6 million eligible patients receive lung cancer screening. Most of these patients are current smokers, yet few receive effective tobacco treatment, with even larger care gaps among African American populations. This problem requires solutions at multiple levels, as uptake of lung cancer screening and tobacco treatment are driven by both physician orders and patient receipt of care. Novel, personalized efforts that target physicians and patients may boost uptake in lung cancer screening and tobacco treatment. We propose a multi-level intervention featuring a precision risk tool designed to stimulate guideline-concordant care by motivating behavior change and facilitating patient- centered discussions between primary care physicians and medically underserved patients at risk for lung cancer. This innovation is motivated by two key findings: 1) clinical and genetic factors inform precision risk for lung cancer and smoking cessation, and 2) high desire for personal genetic risk feedback signals its potential to activate behavior change. Building on important genomic advances, our team developed RiskProfile, a physician- and patient-facing tool that can incorporate genetic risk feedback to promote evidence-based care and cancer risk-reducing behaviors. The overarching goal of this study is to test the impact of RiskProfile, either with or without genetic information and in comparison to usual care, on uptake of lung cancer screening and tobacco treatment. We propose a 3-arm cluster randomized controlled trial of 75 physicians and 825 screen-eligible patients (11 per physician) from a diverse primary care setting. Physicians and patients will be randomized to usual care vs. RiskProfile-Clin (based on clinical factors) vs. RiskProfile-Gen (based on clinical and genetic factors) to evaluate the effect of precision risk interventions on lung cancer screening and tobacco treatment. In Aims 1 and 2, we will test the effect of RiskProfile on physician orders and patient completion of lung cancer screening and tobacco treatment. We predict that RiskProfile-Gen will outperform RiskProfile-Clin, and that both groups will outperform usual care. Primary outcomes will be ordering and completion of lung cancer screening among screen-eligible patients. Secondary outcomes will be ordering and receiving tobacco treatment among screen-eligible current smokers. In Aim 3, we will explore the impact of RiskProfile on potential mechanisms of behavior change (physician perceptions, patient cognitive or engagement factors, and physician-patient interactions) that may increase uptake of lung cancer screening and tobacco treatment. By targeting both physicians and patients and addressing both cancer screening and cessation care, this precision risk feedback tool has potential to drive down lung cancer incidence and mortality in underserved populations.