Health Services Research & Development

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Kathuria H, Koppelman E, Borrelli B, Slatore CG, Clark JA, Lasser KE, Wiener RS. Patient-Physician Discussions on Lung Cancer Screening: A Missed Teachable Moment to Promote Smoking Cessation. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco. 2018 Nov 23.
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Abstract: Introduction: Little is known about whether patients and physicians perceive lung cancer screening as a teachable moment to promote smoking cessation or the degree to which physicians in 'real world' settings link lung cancer screening discussions with smoking cessation counseling. We sought to characterize patient and physician perspectives of discussions about smoking cessation during lung cancer screening. Methods: We conducted a qualitative study (interviews and focus groups) with 21 physicians and 28 smokers screened in 4 diverse hospitals. Transcripts were analyzed for characteristics of communication about smoking cessation and lung cancer screening, the perceived effect on motivation to quit smoking, the degree to which physicians leverage lung cancer screening as a teachable moment to promote smoking cessation, and suggestions to improve patient-physician communication about smoking cessation in the context of lung cancer screening. Results: Patients reported that lung cancer screening made them more cognizant of the health consequences of smoking, priming them for a teachable moment. While physicians and patients both acknowledged that smoking cessation counseling was frequent, they described little connection between their discussions regarding lung cancer screening and smoking cessation counseling. Physicians identified several barriers to integrating discussions on smoking cessation and lung cancer screening. They volunteered communication strategies by which lung cancer screening could be leveraged to promote smoking cessation. Conclusions: Lung cancer screening highlights the harms of smoking to patients who are chronic, heavy smokers and thus may serve as a teachable moment for promoting smoking cessation. However, this opportunity is typically missed in clinical practice. Implications: Lung cancer screening highlights the harms of smoking to heavily addicted smokers. Yet both physicians and patients reported little connection between lung cancer screening and tobacco treatment discussions due to multiple barriers. On-site tobacco treatment programs and post-screening messaging tailored to the lung cancer screening results is needed to maximize the health outcomes of lung cancer screening, including smoking quit rates and longer-term smoking-related morbidity and mortality.