Grant Details
Grant Number: |
1R01CA207048-01 Interpret this number |
Primary Investigator: |
Hays, J |
Organization: |
Mayo Clinic Rochester |
Project Title: |
Smoking Cessation in Lung Cancer Screening: Integrated Digital/Clinical Approach |
Fiscal Year: |
2016 |
Abstract
PROJECT SUMMARY
Delivering effective tobacco dependence treatment that is feasible within low dose spiral CT (LDCT) clinics is crucial
for realizing the health benefits of lung cancer screening. The Centers for Medicare and Medicaid Services requires
that LDCT shared decision making with smokers include “counseling on the importance of smoking cessation and
furnishing of information about tobacco cessation interventions.” This approach is analogous to the Ask-Advise-Refer
(AAR) model in which providers Ask about smoking status, Advise a smoker to quit, and Refer to cessation resources.
To date, passive referral to treatment has failed to increase treatment use. Proactively connecting smokers to
treatment can increase treatment use. Emerging evidence supports the effectiveness and cost efficiency of proactively
linking smokers to digital cessation treatment through the electronic health record (EHR). Digital interventions (i.e.,
web-based and text message) are effective, sustainable, scalable, and cost efficient. Use of digital technologies is
common among older adults and continues to increase steadily as the sizable population of digitally-connected middle
aged adults ages. This study will evaluate the impact of a proactive, EHR-supported enrollment strategy that links
LDCT-eligible smokers with an evidence-based intervention comprised of a web-based program and integrated text
messaging. The scalability and sustainability of a digital intervention may represent the most cost effective and
feasible approach for LDCT clinics to proactively engage large numbers of smokers in modestly effective cessation
treatment. However, given that patients seen in LDCT clinics will be older, established heavy smokers with varying
levels of interest in quitting, we will also evaluate the impact and cost effectiveness of adding proven clinical
intervention provided by a tobacco treatment specialist. We expect that a combined digital/clinical intervention will yield
higher quit rates than digital alone, but that it may not be as cost effective or feasible for LDCT clinics to implement.
Our goal is to provide actionable findings about how to most effectively and cost efficiently promote abstinence in
LDCT clinics. Using a 3-arm randomized trial design with repeated measures at 1, 3, 6, and 12 months, we will
randomize N=1650 smokers who present for LDCT lung cancer screening to an passive referral usual care control
condition, proactive referral to a digital cessation intervention that combines web and text messaging, or proactive
referral to a digital cessation intervention combined with Tobacco Treatment Specialist counseling. We will examine
overall effectiveness of the interventions in promoting abstinence, the impact of proactive referral to treatment, and the
total cost and cost effectiveness of the interventions. We will also examine the representativeness of the enrolled
sample and explore barriers and facilitators to intervention adoption with LDCT clinic leaders. Our trial is structured as
a practical clinical trial to answer key questions of direct relevance to LDCT decision-makers. The study is innovative
in its use of interoperable, digital technologies to deliver a sustainable, scalable, high impact cessation intervention
and to facilitate its integration within clinical practice. This study will add to the growing knowledge base about the
overall effectiveness of digital interventions and their role in the healthcare delivery system.
Publications
Lung Cancer Screening and Smoking Cessation Clinical Trials. SCALE (Smoking Cessation within the Context of Lung Cancer Screening) Collaboration.
Authors: Joseph A.M.
, Rothman A.J.
, Almirall D.
, Begnaud A.
, Chiles C.
, Cinciripini P.M.
, Fu S.S.
, Graham A.L.
, Lindgren B.R.
, Melzer A.C.
, et al.
.
Source: American journal of respiratory and critical care medicine, 2018-01-15; 197(2), p. 172-182.
PMID: 28977754
Related Citations
An integrated digital/clinical approach to smoking cessation in lung cancer screening: study protocol for a randomized controlled trial.
Authors: Graham A.L.
, Burke M.V.
, Jacobs M.A.
, Cha S.
, Croghan I.T.
, Schroeder D.R.
, Moriarty J.P.
, Borah B.J.
, Rasmussen D.F.
, Brookover M.J.
, et al.
.
Source: Trials, 2017-11-28; 18(1), p. 568.
EPub date: 2017-11-28.
PMID: 29179734
Related Citations