Interviews With Patients Offered Lung Cancer Screening in Primary Care: Lessons in How Screening May Influence Smoking Cessation

BackgroundLung cancer screening with low-dose computed tomography (LDCT) has been shown to decrease mortality. Low lung cancer survival rates in the UK, driven primarily by late-stage presentation, provide the impetus for implementing screening. Nascent guidance on screening in the UK recommends primary care case-finding. However, the potential impact and acceptability on primary care, and the opportunistic utilisation of other case-finding routes, such as pharmacies, smoking cessation services, and respiratory clinics, have not been fully explored.AimTo explore healthcare professionals’ views and perspectives about lung cancer screening and their preparedness and willingness to be involved in its implementation.Design & settingA qualitative study was carried out with semi-structured interviews conducted with GPs, pharmacists, staff from smoking cessation services within Southwark and Lambeth in London, and staff from respiratory clinics in Guys’ and St Thomas’ NHS Foundation Trust in London between April 2018 and December 2018.MethodSixteen participants were interviewed and the interview transcripts were analysed thematically.ResultsParticipants described lung cancer screening as an important diagnostic tool for capturing lung cancer at an earlier stage and in increasing survivorship. However, the majority expressed a lack of awareness and understanding, uncertainty and concerns about the validity of screening, and the potential impact on their patients and workload.ConclusionStudy participants had mixed opinions about lung cancer screening and expressed their concerns about its implementation. Addressing these concerns by providing resources and effective and detailed guidelines for their use may lead to greater engagement and willingness to be involved in lung cancer screening.

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Healthcare professionals’ perspectives on lung cancer screening in the UK: a qualitative study

British Journal of General Practice ◽

10.3399/bjgp20x711449 ◽

2020 ◽

Vol 70 (suppl 1) ◽

pp. bjgp20X711449 ◽

Cited By ~ 1

Author(s):

Charikleia Margariti ◽

Maria Kordowicz ◽

Gillian Selman ◽

Arjun Nair ◽

Yvonne Akande ◽

...

Keyword(s):

Lung Cancer ◽

Primary Care ◽

Smoking Cessation ◽

Cancer Screening ◽

Healthcare Professionals ◽

Lung Cancer Screening ◽

Case Finding ◽

Smoking Cessation Services ◽

Potential Impact ◽

The Uk

BackgroundLung cancer screening with low-dose CT has been shown to decrease mortality. Low lung cancer survival rates in the UK, driven primarily by late-stage presentation, provide the impetus for implementing screening. Nascent guidance on screening in the UK recommends primary care case-finding. However, the potential impact and acceptability on primary care, and the opportunistic utilisation of other case-finding routes such as pharmacies, smoking cessation services and respiratory clinics, have not been fully explored.AimTo explore healthcare professionals’ views and perspectives about lung cancer screening and their preparedness and willingness to be involved in its implementation.MethodA qualitative study was carried out with semi-structured interviews conducted with GPs, pharmacists and staff from smoking cessation services within Southwark and Lambeth and from respiratory clinics in Guy’s and St. Thomas’ NHS Trust in London in 2018. Sixteen participants were interviewed, and the interview transcripts were analysed thematically.ResultsParticipants described lung cancer screening as an important diagnostic tool for capturing lung cancer at an earlier stage and in increasing survivorship. However, the majority expressed a lack of awareness and understanding, uncertainty and concerns about the validity of screening, its misuse and the potential impact on their patients and workload.ConclusionStudy participants had mixed opinions about lung cancer screening and expressed their concerns about its implementation. Addressing these concerns by providing resources and effective and detailed guidelines for their use may lead to greater engagement and willingness to be involved in lung cancer screening.

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Smoking cessation and shared decision‐making practices about lung cancer screening among primary care providers

Cancer Medicine ◽

10.1002/cam4.3714 ◽

2021 ◽

Author(s):

Maria A. Lopez‐Olivo ◽

Jennifer A. Minnix ◽

James G. Fox ◽

Shawn P. E. Nishi ◽

Lisa M. Lowenstein ◽

...

Keyword(s):

Lung Cancer ◽

Primary Care ◽

Decision Making ◽

Smoking Cessation ◽

Cancer Screening ◽

Shared Decision Making ◽

Lung Cancer Screening ◽

Primary Care Providers ◽

Shared Decision ◽

Care Providers

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CONNECT: Smoking Cessation and Lung Cancer Screening

Case Medical Research ◽

10.31525/ct1-nct04149249 ◽

2019 ◽

Author(s):

Keyword(s):

Lung Cancer ◽

Smoking Cessation ◽

Cancer Screening ◽

Lung Cancer Screening

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Receipt of Tobacco Treatment and One-Year Smoking Cessation Rates Following Lung Cancer Screening in the Veterans Health Administration

Journal of General Internal Medicine ◽

10.1007/s11606-021-07011-0 ◽

2021 ◽

Author(s):

Jaimee L. Heffner ◽

Scott Coggeshall ◽

Chelle L. Wheat ◽

Paul Krebs ◽

Laura C. Feemster ◽

...

Keyword(s):

Lung Cancer ◽

Smoking Cessation ◽

Cancer Screening ◽

Lung Cancer Screening ◽

Veterans Health Administration ◽

Veterans Health ◽

Health Administration ◽

Tobacco Treatment ◽

One Year

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Cost-Effectiveness of Smoking Cessation Interventions in the Lung Cancer Screening Setting: A Simulation Study

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djab002 ◽

2021 ◽

Cited By ~ 1

Author(s):

Christopher J Cadham ◽

Pianpian Cao ◽

Jinani Jayasekera ◽

Kathryn L Taylor ◽

David T Levy ◽

...

Keyword(s):

Lung Cancer ◽

Smoking Cessation ◽

Cost Effectiveness ◽

Cancer Screening ◽

Task Force ◽

Lung Cancer Screening ◽

Cancer Registries ◽

Web Based ◽

Screening Programs ◽

Life Years

Abstract Background Guidelines recommend offering cessation interventions to smokers eligible for lung cancer screening, but there is little data comparing specific cessation approaches in this setting. We compared the benefits and costs of different smoking cessation interventions to help screening programs select specific cessation approaches. Methods We conducted a societal-perspective cost-effectiveness analysis using a Cancer Intervention and Surveillance Modeling Network model simulating individuals born in 1960 over their lifetimes. Model inputs were derived from Medicare, national cancer registries, published studies, and micro-costing of cessation interventions. We modeled annual lung cancer screening following 2014 US Preventive Services Task Force guidelines plus cessation interventions offered to current smokers at first screen, including pharmacotherapy only or pharmacotherapy with electronic and/or web-based, telephone, individual, or group counseling. Outcomes included lung cancer cases and deaths, life-years saved, quality-adjusted life-years (QALYs) saved, costs, and incremental cost-effectiveness ratios. Results Compared with screening alone, all cessation interventions decreased cases of and deaths from lung cancer. Compared incrementally, efficient cessation strategies included pharmacotherapy with either web-based cessation ($555 per QALY), telephone counseling ($7562 per QALY), or individual counseling ($35 531 per QALY). Cessation interventions continued to have costs per QALY well below accepted willingness to pay thresholds even with the lowest intervention effects and was more cost-effective in cohorts with higher smoking prevalence. Conclusion All smoking cessation interventions delivered with lung cancer screening are likely to provide benefits at reasonable costs. Because the differences between approaches were small, the choice of intervention should be guided by practical concerns such as staff training and availability.

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An Assessment of Primary Care and Pulmonary Provider Perspectives on Lung Cancer Screening

Annals of the American Thoracic Society ◽

10.1513/annalsats.201705-392oc ◽

2018 ◽

Vol 15 (1) ◽

pp. 69-75 ◽

Cited By ~ 27

Author(s):

Matthew Triplette ◽

Erin K. Kross ◽

Blake A. Mann ◽

Joann G. Elmore ◽

Christopher G. Slatore ◽

...

Keyword(s):

Lung Cancer ◽

Primary Care ◽

Cancer Screening ◽

Lung Cancer Screening ◽

Provider Perspectives

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Implementing lung cancer screening in primary care: needs assessment and implementation strategy design

Translational Behavioral Medicine ◽

10.1093/tbm/ibab115 ◽

2021 ◽

Author(s):

Thomas J Reese ◽

Chelsey R Schlechter ◽

Heidi Kramer ◽

Polina Kukhareva ◽

Charlene R Weir ◽

...

Keyword(s):

Lung Cancer ◽

Primary Care ◽

Cancer Screening ◽

Decision Aid ◽

Low Dose ◽

Implementation Strategies ◽

Lung Cancer Screening ◽

Behavioral Determinants ◽

Causal Pathways ◽

Task Behaviors

Abstract Lung cancer screening with low-dose computed tomography (CT) could help avert thousands of deaths each year. Since the implementation of screening is complex and underspecified, there is a need for systematic and theory-based strategies. Explore the implementation of lung cancer screening in primary care, in the context of integrating a decision aid into the electronic health record. Design implementation strategies that target hypothesized mechanisms of change and context-specific barriers. The study had two phases. The Qualitative Analysis phase included semi-structured interviews with primary care physicians to elicit key task behaviors (e.g., ordering a low-dose CT) and understand the underlying behavioral determinants (e.g., social influence). The Implementation Strategy Design phase consisted of defining implementation strategies and hypothesizing causal pathways to improve screening with a decision aid. Three key task behaviors and four behavioral determinants emerged from 14 interviews. Implementation strategies were designed to target multiple levels of influence. Strategies included increasing provider self-efficacy toward performing shared decision making and using the decision aid, improving provider performance expectancy toward ordering a low-dose CT, increasing social influence toward performing shared decision making and using the decision aid, and addressing key facilitators to using the decision aid. This study contributes knowledge about theoretical determinants of key task behaviors associated with lung cancer screening. We designed implementation strategies according to causal pathways that can be replicated and tested at other institutions. Future research is needed to evaluate the effectiveness of these strategies and to determine the contexts in which they can be effectively applied.

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