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

项目摘要/摘要 肺癌是最致命的癌症形式，80%以上的肺癌和肺癌死亡病例 由吸烟引起的。每年一次的低剂量计算机断层扫描筛查肺癌 推荐给长期吸烟者，但760万符合条件的患者中只有2% 接受肺癌筛查。这些患者中的大多数都是目前吸烟者，但很少有人接受有效的烟草治疗 治疗方面，非裔美国人群体中的护理差距更大。此问题需要在以下位置解决 多层次，因为肺癌筛查和烟草治疗的接受是由这两个医生的命令推动的 以及病人接受护理的情况。针对医生和患者的新颖、个性化的努力可能会促进对 肺癌筛查和烟草治疗。我们提出了以精准风险为特征的多层次干预 旨在通过激励行为改变和促进患者-来刺激符合指南的护理的工具 初级保健医生和有肺部风险的医疗服务不足的患者之间的集中讨论 癌症。这一创新是由两个关键发现推动的：1)临床和遗传因素决定了精确的风险 肺癌和戒烟，以及2)对个人遗传风险反馈的高度渴望表明其潜力 来激活行为改变。在重要的基因组进展的基础上，我们团队开发了RiskProfile，一种 面向医生和患者的工具，可以结合遗传风险反馈来促进循证护理 以及降低癌症风险的行为。这项研究的首要目标是测试RiskProfile的影响， 无论有没有遗传信息，与通常的护理相比，对肺癌筛查的吸收 和烟草治疗。我们提出了一项包括75名医生和825名医生的3臂整群随机对照试验 筛查符合条件的患者(每个医生11名)，来自不同的初级保健环境。医生和患者将 随机分为常规护理与RiskProfile-Clin(基于临床因素)与RiskProfile-Gen(基于临床 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和目标2中，我们将测试RiskProfile对医生订单和患者完成的影响 肺癌筛查和烟草治疗。我们预测RiskProfile-Gen的表现将优于RiskProfile-Clin， 而且这两组人的表现都会超过通常的护理。主要结果将是肺的有序和完成 对符合筛查条件的患者进行癌症筛查。次要结果将是订购和接收烟草 对符合筛查条件的当前吸烟者进行治疗。在目标3中，我们将探讨RiskProfile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 医生与患者之间的互动)，这可能会增加肺癌筛查和烟草治疗的接受度。通过 以医生和患者为目标，同时解决癌症筛查和戒烟护理，这种精确度 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.