Integrating Evidence-Based Smoking Cessation Interventions into Lung Cancer Screening Programs: A Randomized Trial

通过CT筛查和早期疾病治疗，肺癌死亡率可降低20%。极大值 只有在接受肺部筛查的高危吸烟者获得 协助戒烟。虽然有几种已知的有效戒烟干预措施，但其中许多是 不能在不同的社区肺癌筛查项目中推广，也不能在非吸烟者中推广 寻求戒烟治疗。我们的目标是开发一种可扩展且经济高效的戒烟干预措施 广泛实施，为个人和社会带来最大的利益和最低的成本。 在RE-AIM框架的指导下，我们提出了一个实用的电话咨询RCT，设计于 可伸缩性和强度的交汇点，为未来在全国烟草戒烟线内实施。我们的 经验丰富的团队将对1330名在5岁时登记进行筛查的吸烟者进行随机试验 不同的筛查地点，比较：1)常规护理(UC)：参与者发起(被动的)电话咨询 (TC)，吸烟者得到转介，要求参加最多8次咨询会议的标准方案，以及 免费的NRT，与2)多层面的、8次会议的、由辅导员主动发起的电话咨询(CITC) 根据筛查结果量身定做的方案，筛查时提供NRT，并提供初级保健 订婚。在筛查诊所，说英语和西班牙语的人都会收到戒烟的简短建议 烟草治疗专家将进行TC。CITC分支的目标是利用 肺筛查的可教时刻提供了更多的动力，并抵消了 在正常结果下戒烟的动力减弱。此外，我们方法的两个重要方面包括 癌症干预和监测模型网络的成本-效果分析和使用 评估干预措施的成本与其对与吸烟相关的短期和长期影响 结果。包括所有吸烟者，无论他们是否愿意戒烟，使他们与烟草相关的健康个性化 风险，并提供基于证据的戒烟干预，我们预计CITC的ARM将产生 更高的离职率，具有广泛实施的极好潜力，导致成本- 有效干预。其目的是：1)比较辅导员发起的电话咨询(CITC)和 日常护理(UC)转诊至标准电话咨询，经过生化验证的7天、30天和 持续的禁欲。将对干预调解人和主持人进行评估。2)评估REACH和 干预措施的参与。3)进行CITC与UC在单位成本方面的成本效益分析 6个月和12个月的禁酒率和戒烟尝试。CINET模型将预测以下方面的长期影响 肺癌死亡率每寿命年成本和质量调整后寿命年的干预研究 减少，以及总体人口死亡率。这项研究将对公共卫生产生重大影响， 提供关键数据以应对筛查中心、保险公司和政策制定者的可扩展性努力。

Lung cancer mortality can be reduced by 20% via CT screening and treatment of early stage disease. Maximum health impact from screening will only be achieved if high-risk smokers undergoing lung screening receive assistance to stop smoking. While there are several known effective cessation interventions, many of these are not scalable within diverse community-based lung cancer screening programs or with smokers who are not seeking cessation treatment. Our goal is to develop a scalable and cost-effective cessation intervention for widespread implementation to yield the greatest benefits and the lowest costs to both individuals and society. Guided by the RE-AIM Framework, we are proposing a pragmatic telephone counseling RCT, designed at the intersection of scalability and intensity, for future implementation within the national tobacco quitline. Our experienced team will conduct a randomized trial of 1330 smokers who have registered for screening at 5 diverse screening sites, comparing: 1) usual care (UC): participant-initiated (‘reactive’) telephone counseling (TC), in which smokers receive a referral to call in for the standard protocol of up to 8 counseling sessions and free NRT, vs. 2) a multi-faceted, 8-session, ‘proactive,’ counselor-initiated telephone counseling (CITC) protocol, tailored on screening result, with NRT provided at the screening exam, and with primary care engagement. Both arms receive brief advice to quit at the screening clinic, both English and Spanish speakers are included, and tobacco treatment specialists will conduct the TC. The goal of the CITC arm is to leverage the increased motivation provided by the teachable moment of lung screening and to counteract the potential for reduced motivation to quit following a normal result. Further, two important aspects of our approach include a cost-effectiveness analysis and use of the Cancer Intervention and Surveillance Modeling Network (CISNET) to evaluate the costs of the interventions relative to their impact on short- and long-term smoking-related outcomes. By including all smokers, regardless of readiness to quit, personalizing their tobacco-related health risks, and providing an evidence-based cessation intervention, we expect that the CITC arm will yield substantially higher quit rates with excellent potential for widespread implementation, resulting in a cost- effective intervention. The aims are: 1) To compare counselor-initiated telephone counseling (CITC) vs. usual care (UC) referral to standard telephone counseling, with biochemically verified 7-day, 30-day, and sustained abstinence. Intervention mediators and moderators will be assessed. 2) To evaluate reach and engagement of the interventions. 3) To conduct a cost-effectiveness analysis of CITC vs UC, in terms of cost per 6- and 12-month abstinence rates and quit attempts. The CISNET model will project the long-term impact of the interventions on cost per life year saved and quality-adjusted life years saved, lung cancer mortality reduction, and overall population mortality. This study will have a substantial public health impact by providing critical data to address scalability efforts by screening centers, insurers, and policy-makers.