Promoting Smoking Cessation in Lung Cancer Screening Through Proactive Treatment

VA Office of Research and Development944 enrolled

Overview

This pragmatic trial will evaluate the value of routinely providing proactive smoking cessation support to current smokers as a part of participating in lung cancer screening within Veterans Health Administration.

This trial is a pragmatic randomized trial targeting the care of current smokers who are participating in lung cancer screening at two VA sites. Primary care providers at these sites will be randomized, and half will be offered tools to help integrate proactive smoking cessation support into the lung cancer screening process. Key proactive elements include proactive telephone outreach to all current smokers by a VA Quitline counselor that follows mailed results letters, and providing providers guidance in offering proactive cessation medication support as part of the lung cancer screening process.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

944

Conditions

Smoking Reduction Tobacco Use Tobacco Smoking Tomography Lung Diseases Lung Neoplasms

Interventions

Unsigned note to provider about cessation medication prescriptionBEHAVIORAL

For patients of providers assigned to the proactive study group, a local coordinator will review the patient's cessation medication history. If the patient is not currently being provided cessation support medication, the coordinator will enter a note for the provider about the recommended medication indicated by VA formulary guidelines.

Proactive Telephone Counseling from VA QuitlineBEHAVIORAL

Patients of providers assigned to the proactive study group will be contacted by specially trained counselors at the VA Quitline. Counselors will attempt to provide two sessions of proactive telephone support.

Eligibility

Sex: ALLMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Providers who schedule patients for a lung cancer screening at either of the two VA sites. * Patients who participate in lung cancer screening and are current smokers at the time of scheduling their screening exam. Exclusion Criteria: * Providers who currently systematically prescribe cessation support medication to all current smokers will be excluded. * Patients with urgent findings requiring biopsy/immediate attention on the screening CT will be excluded. * Patients with a prior diagnosis of lung cancer or who are receiving active therapy for any cancer, except skin cancer, will be excluded. * Patients previously diagnosed with cognitive impairment, dementia, or severe behavioral disorders, or have an indication in chart review of difficulty communicating or participating in telephone counseling sessions will be excluded.

Locations (3)

Manhattan Campus of the VA NY Harbor Healthcare System, New York, NY

New York, New York, United States

Providence VA Medical Center, Providence, RI

Providence, Rhode Island, United States

VA Puget Sound Health Care System Seattle Division, Seattle, WA

Seattle, Washington, United States

Outcomes

Primary Outcomes

Self-reported Smoking Abstinence

The primary outcome measure is self-reported abstinence from smoking 12 months after lung cancer screening, using information obtained from study surveys and electronic medical records. This measure only applies to patient enrollees.

Time frame: 12 months after lung cancer screening visit

Secondary Outcomes

Cost of Smoking Cessation Care

Costs of implementing smoking cessation care from lung cancer screening to 12 months post-lung cancer screening will be monitored in both the unstructured and proactive care arms. Cost of implementing smoking cessation care is defined as the sum of the cost of behavioral counseling, cost of pharmacotherapies, and cost of intervention staff effort. This measure only applies to patient enrollees.

Time frame: Time period from lung cancer screening through 12 months after lung cancer screening

Patients' Experience With Telephone Counseling

Binary variable for whether participant reported being either very satisfied or somewhat satisfied with VA Quitline telephone counseling. This measure only applies to patient enrollees in the proactive arm.

Time frame: 3 months after lung cancer screening visit

Patients' Motivational Assessment

Surveys will assess patient motivation to quit smoking on a scale from 0-10 (higher scores indicate higher motivation to quit smoking). This measure only applies to patient enrollees.

Time frame: 3 months after lung cancer screening visit

Patients' Perception of Susceptibility to Harm

Surveys will assess patients' perceived susceptibility to the harmful effects of smoking and perception of screening as protective. Patients were asked 5 questions related to smoking and screening, and an overall score based on the sum of correct answers was calculated. Scores range from 0-5 (higher scores indicate greater knowledge about harmful effects of smoking and benefits of screening). This measure only applies to patient enrollees.

Data from ClinicalTrials.gov

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