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||Precision Prevention Strategy to Increase Uptake and Engagement in Lung Cancer Screening and Smoking Cessation Treatment
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.
Genomic medicine to reduce tobacco and related disorders: Translation to precision prevention and treatment.
, Baker T.B.
, Ramsey A.
, Amos C.I.
, Bierut L.J.
Addiction neuroscience, 2023 Sep; 7, .