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McFadden K, Nickel B, Rankin NM, Li T, Jennett CJ, Sharman A, Quaife SL, Houssami N, Dodd RH. Participant factors associated with psychosocial impacts of lung cancer screening: A systematic review. Cancer Med 2024; 13:e70054. [PMID: 39096118 DOI: 10.1002/cam4.70054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 05/29/2024] [Accepted: 07/18/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Psychosocial impacts of lung cancer screening (LCS) can cause both harm to individuals and serve as barriers to screening participation and adherence. Early data suggest that the psychosocial impacts of LCS are moderated by certain factors (e.g. sociodemographic characteristics and beliefs), but evidence synthesis is lacking. This systematic review aimed to understand individual-level risk factors for psychosocial burden during LCS as a precursor to developing strategies to identify and support participants, and improve LCS engagement. METHODS Four databases were searched for full-text articles published in English reporting any association between participant factors and psychosocial outcomes experienced during LCS. Study quality was assessed by two independent investigators; findings were synthesised narratively. The review was pre-registered with PROSPERO and adhered to PRISMA guidelines. RESULTS Thirty-five articles were included; most (33/35) studies were assessed at high or moderate risk of bias. Study designs were pre-post (n = 13), cross-sectional (n = 13), qualitative (n = 8) and mixed-methods (n = 1) and conducted primarily in the United States (n = 17). Psychological burden in LCS varied, and was often associated with younger age, female gender, current smoking status or increased smoking history, lower education, lower socio-economic group, not being married or co-habiting and experience with cancer. However, results were mixed, and non-significant associations were also reported across all factors. Beliefs (e.g. fatalism, stigma and expectation of LDCT results) and comorbid psychological burden were also linked to psychosocial outcomes, but evidence was sparse. Associations between risk perception, other participant factors and other psychosocial outcomes was inconclusive, likely reflecting individual biases in risk conceptualisation. CONCLUSION(S) Several participant factors are consistently reported to be associated with psychosocial impacts of LCS, though study heterogeneity and high risk of bias necessitate more robust evaluation. Further research on how perceptions, beliefs and expectations can be used to improve psychosocial outcomes during LCS is needed.
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Affiliation(s)
- Kathleen McFadden
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Brooke Nickel
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Nicole M Rankin
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Tong Li
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Chloe J Jennett
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ashleigh Sharman
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Samantha L Quaife
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Nehmat Houssami
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Rachael H Dodd
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
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Tsiligianni I, Christodoulakis A, Monastirioti A, Mavroudis D, Agelaki S. The journey of lung cancer patients from symptoms to diagnosis in Greece. A mixed methods approach. NPJ Prim Care Respir Med 2024; 34:5. [PMID: 38684681 PMCID: PMC11058196 DOI: 10.1038/s41533-024-00359-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 02/27/2024] [Indexed: 05/02/2024] Open
Abstract
The early diagnosis of lung cancer improves the probability of successful treatment. However, patients and physicians face several difficulties that can considerably delay the diagnostic process. A mixed-methods study that would follow the patient's journey throughout the diagnostic process could alleviate these difficulties. This study aimed to (a) track the patients' journey from the onset of symptoms until diagnosis and, (b) explore the patients' perspective of the journey until diagnosis, on the largest island of Greece. A convergent mixed-methods study was conducted with 94 patients with lung cancer. Patients completed a self-report questionnaire and were interviewed about their symptoms and journey through the healthcare system before their diagnosis. Our findings revealed several problems and delays in the diagnostic process. Both quantitative and qualitative data showed that patients did not recognize their symptoms and sought medical advice in time because they overlooked or attributed their symptoms to 'simpler'/'more common' causes. Furthermore, most patients were diagnosed 1-3 months after their first visit to a physician for their symptoms. Qualitative data analysis revealed three broad categories of problems that delayed diagnosis: (1) physician missteps, (2) administrative problems, and (3) the effect of the Covid-19 pandemic. This study found that major issues and delays prolong the diagnostic process for lung cancer. Therefore, optimization of diagnostic processes at each level of healthcare and interspecialty cooperation programs are needed. Furthermore, population-based interventions and patient education can help lung cancer patients be diagnosed early and improve their quality of life and disease outcomes.
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Affiliation(s)
- Ioanna Tsiligianni
- Department of Social Medicine, School of Medicine, University of Crete, Crete, Greece.
| | - Antonios Christodoulakis
- Department of Social Medicine, School of Medicine, University of Crete, Crete, Greece
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, Crete, Greece
| | - Alexia Monastirioti
- Department of Medical Oncology, School of Medicine, University of Crete, Crete, Greece
| | - Dimitrios Mavroudis
- Department of Medical Oncology, School of Medicine, University of Crete, Crete, Greece
| | - Sofia Agelaki
- Department of Medical Oncology, School of Medicine, University of Crete, Crete, Greece
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McFadden K, Rankin NM, Nickel B, Li T, Jennett CJ, Sharman AR, Quaife SL, Dodd RH, Houssami N. Lung cancer screening program factors that influence psychosocial outcomes: A systematic review. Psychooncology 2024; 33:e6252. [PMID: 37971147 DOI: 10.1002/pon.6252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/29/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Lung cancer screening (LCS) programs are being designed and implemented globally. Early data suggests that the psychosocial impacts of LCS are influenced by program factors, but evidence synthesis is needed. This systematic review aimed to elucidate the impact of service-level factors on psychosocial outcomes to inform optimal LCS program design and future implementation. METHODS Four databases were searched from inception to July 2023. Inclusion criteria were full-text articles published in English that reported an association between any program factors and psychosocial outcomes experienced during LCS. Study quality was appraised, and findings were synthesised narratively. RESULTS Thirty-two articles were included; 29 studies were assessed at high or moderate risk of bias. Study designs were RCT (n = 3), pre-post (n = 6), cross-sectional (n = 12), mixed-methods (n = 1), and qualitative (n = 10) studies, and conducted primarily in the USA (n = 25). Findings suggested that targeted interventions can improve smoking-related or decisional psychosocial outcomes (e.g., smoking cessation interventions increase readiness/motivation to quit) but impacts of interventions on other psychological outcomes were varied. There was limited evidence reporting association between service delivery components and psychological outcomes, and results suggested moderation by individual aspects (e.g., expectation of results, baseline anxiety). Opportunities for discussion were key in reducing psychological harm. CONCLUSIONS Certain program factors are reportedly associated with psychosocial impacts of LCS, but study heterogeneity and quality necessitate more real-world studies. Future work should examine (a) implementation of targeted interventions and high-value discussion during LCS, and (b) optimal methods and timing of risk and result communication, to improve psychosocial outcomes while reducing time burden for clinicians.
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Affiliation(s)
- Kathleen McFadden
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Nicole M Rankin
- Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Brooke Nickel
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Tong Li
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Chloe J Jennett
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ashleigh R Sharman
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Samantha L Quaife
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Rachael H Dodd
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Nehmat Houssami
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia
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Lei F, Chen WT, Brecht ML, Zhang ZF, Hu Y, Xu T, Wang S, Lee E. Cross-Cultural Adaptation of Lung Cancer Screening Health Belief Scale in Chinese Americans: A Methodological Study. J Nurs Meas 2023; 31:489-501. [PMID: 37871962 DOI: 10.1891/jnm-2021-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Background and Purpose: The purpose of this study is to report the process of adapting the existing Lung Cancer Screening Health Belief Scale to be used in Chinese Americans. Methods: Guided by Flaherty et al.'s cross-cultural equivalency model, the methodology used in the adaptation process consists of four steps, including preliminary modification after a comprehensive literature review, forward and backward translation, expert review, and cognitive interviews among participants. Results: The modified culturally fitted Lung Cancer Screening Health Belief Scale included 57 items and 6 subscales, which proved highly reliable and valid through the expert review and participants' review. Conclusions: This study provided an example for a novice cross-cultural researcher to adapt an instrument to be used in another population with a different language. Further research is needed to work out a standard guideline for cross-cultural instrument adaptation.
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Affiliation(s)
- Fang Lei
- University of Minnesota, Twin Cities, MN, USA
| | - Wei-Ti Chen
- University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Zuo-Feng Zhang
- University of California, Los Angeles, Los Angeles, CA, USA
| | - Yuhe Hu
- Charles B. Wang Health Center, New York, NY, USA
| | - Tuzhen Xu
- Texas Woman's University, Denton, TX, USA
| | - Siqian Wang
- Case Western Reverse University, Cleveland, OH, USA
| | - Eunice Lee
- University of California, Los Angeles, Los Angeles, CA, USA
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Olson RE, Wen EX, Staines Z, Goh F, Marshall HM. Imperatives of health or happiness: Narrative constructions of long-term smoking after undergoing lung screening. Health (London) 2023; 27:1115-1134. [PMID: 35668696 DOI: 10.1177/13634593221099108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tobacco control policies reinforce a health imperative that positions citizens as duty-bound to manage their health by abstaining from or quitting smoking. Limited attention is paid to the repercussions - especially for lung screening - of anti-smoking rhetoric emphasising individual responsibility. Drawing on interviews with 27 long-term smokers involved in an international lung screening trial, this study analysed Australian smokers' narratives of smoking. By attending to stigma and the use of public health rhetoric within personal narratives, we show how narratives underscoring individual responsibility for quitting were layered with conflicting explanations of biological responsibility and normative expectations. Ironically, narratives of individual responsibility potentially undermine smoking cessation. In positioning smokers as responsible for their own healthy choices, such rhetoric also positions smokers as responsible for managing their emotional health, which some did through smoking. Thus, anti-smoking campaigns pit the neoliberal imperative of health against the happiness imperative. These findings have implications for the design and delivery of lung screening campaigns. They also support calls to move beyond health messaging emphasising individual choice, towards acknowledging the moral power of structures and public health campaigns to discipline citizens in unintended ways.
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Vikram A, Muller C, Hulme L. Patients' Views on Medical Events in Lung Cancer Screening as Teachable Moments for Smoking Behaviour Change: A Systematic Review and Metasynthesis. J Smok Cessat 2023; 2023:6647364. [PMID: 37305439 PMCID: PMC10257552 DOI: 10.1155/2023/6647364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 06/13/2023] Open
Abstract
Although medical events in lung cancer screening (LCS) such as receiving scan results or interactions with clinicians are recognised as teachable moments (TMs), the views of patients about why this is the case for smoking behaviour change remain uncertain. This systematic review and metasynthesis study is aimed at identifying the reasons why patients believed that medical events during LCS act as TMs for smoking behaviour change. A search strategy was developed for use with MEDLINE, PsycINFO, EMBASE, CINAHL-P, Web of Science databases, and Google Scholar. This helped identify qualitative and mixed-method research which mentioned patients' views of how these TMs result in smoking behaviour change. After screening, final articles were critically appraised; general characteristics and data relevant to the aims were extracted to conduct a line-of-argument metasynthesis. After screening 695 papers, 11 were included. Undergoing LCS scans was seen to act on their intrinsic motivation to reduce smoking as it served as a "wake-up call" and increased awareness of the health consequences of smoking. Receiving positive or negative LCS results resulted in cessation as it was a "health scare" and challenged smoking habits. Interactions with clinicians addressed misconceptions and signposted them to specialist cessation services. Attendees believed that the following encouraged them to change their smoking behaviour: having an intrinsic motivation to quit, their beliefs on smoking and health reframed, their negative emotions appraised, and using LCS to access specialist support. In line with the TM heuristic, these experiences provided the necessary skills, confidence, and motivation to quit. Future research should explore whether the views of the clinicians match those of the attendees to address misconceptions and further develop clinical guidelines.
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Affiliation(s)
- Anvita Vikram
- Pennine Care NHS Foundation Trust, Manchester BL9 0EQ, UK
| | - Claire Muller
- The University of Manchester, Manchester M13 9PL, UK
| | - Lucy Hulme
- The University of Manchester, Manchester M13 9PL, UK
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Tu J, Uretsky E, Kang L, Yuan J, Zhong J. 'It's not within my control': local explanations for the development of lung cancer in China. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2022; 31:326-341. [PMID: 35731936 DOI: 10.1080/14461242.2022.2085056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 05/29/2022] [Indexed: 06/15/2023]
Abstract
Rates of lung cancer in China are rising rapidly, creating an urgent need for prevention. Effective prevention measures require understanding local beliefs and perceptions about the risk for developing lung cancer. This article explores the explanations that Chinese lung cancer patients and their families give about the aetiology of their disease. Fifty-three interviews were conducted among lung cancer patients and their family members at a large tumour hospital in southern China. Participants presented a complex multifactorial explanation of lung cancer associating their disease with risks like tobacco use, occupational exposures, environmental pollution, lifestyle changes, and personal characters. While these are all standard risk factors commonly associated with lung cancer, participants presented them within a larger contextual frame of structural issues that impede their ability to change their behaviours. Using a social ecological model, we demonstrate how China's socio-cultural environment shapes assumptions about the risk of lung cancer with particular reference to work, home, social situations, and the natural environment.
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Affiliation(s)
- Jiong Tu
- School of Sociology and Anthropology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Elanah Uretsky
- East Asian Studies, Brandeis University, Waltham, MA, USA
| | - Lu Kang
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Juan Yuan
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Jiudi Zhong
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
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8
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Olson RE, Goldsmith L, Winter S, Spaulding E, Dunn N, Mander S, Ryan A, Smith A, Marshall HM. Emotions and lung cancer screening: Prioritising a humanistic approach to care. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5259-e5269. [PMID: 35894098 PMCID: PMC10947369 DOI: 10.1111/hsc.13945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 06/12/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
Low-dose computed tomography lung cancer screening has mortality benefits. Yet, uptake has been low. To inform strategies to better deliver and promote screening, in 2018, we interviewed 27 long-term smokers immediately following lung cancer screening in Australia, prior to receiving scan results. Existing lung screening studies employ the Health Belief Model. Reflecting growing acknowledgement of the centrality of emotions to screening uptake, we draw on psychological and sociological theories on emotions to thematically and abductively analyse the emotional dimensions of lung cancer screening, with implications for screening promotion and delivery. As smokers, interviewees described feeling stigmatised, with female participants internalising and male participants resisting stigma. Guilt and fear related to lung cancer were described as screening motivators. The screening itself elicited mild positive emotions. Notably, interviewees expressed gratitude for the care implicitly shown through lung screening to smokers. More than individual risk assessment, findings suggest lung screening campaigns should prioritise emotions. Peer workers have been found to increase cancer screening uptake in marginalised communities, however the risk to confidentiality-especially for female smokers-limits its feasibility in lung cancer screening. Instead, we suggest involving peer consultants in developing targeted screening strategies that foreground emotions. Furthermore, findings suggest prioritising humanistic care in lung screening delivery. Such an approach may be especially important for smokers from low socioeconomic backgrounds, who perceive lung cancer screening and smoking as sources of stigma and face a higher risk of dying from lung cancer and lower engagement with screening.
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Affiliation(s)
- Rebecca E. Olson
- School of Social ScienceThe University of QueenslandSt LuciaQueenslandAustralia
| | | | - Sara Winter
- School of Applied PsychologyGriffith UniversityMt GravattQueenslandAustralia
| | | | - Nicola Dunn
- The Prince Charles HospitalChermsideQueenslandAustralia
| | - Sarah Mander
- Psychology DepartmentThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Alyssa Ryan
- Cancer Care ServicesThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Alexandra Smith
- School of Social ScienceThe University of QueenslandSt LuciaQueenslandAustralia
| | - Henry M. Marshall
- University of Queensland Thoracic Research Centre and Department of Thoracic MedicineThe Prince Charles HospitalChermsideQueenslandAustralia
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Golden SE, Schweiger L, Melzer AC, Ono SS, Datta S, Davis JM, Slatore CG. "It's a decision I have to make": Patient perspectives on smoking and cessation after lung cancer screening decisions. Prev Med Rep 2022; 30:102014. [PMID: 36237837 PMCID: PMC9551209 DOI: 10.1016/j.pmedr.2022.102014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/17/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022] Open
Abstract
Few studies exist showing that involvement in lung cancer screening (LCS) leads to a change in rates of cigarette smoking. We investigated LCS longitudinally to determine whether teachable moments for smoking cessation occur downstream from the initial provider-patient LCS shared decision-making discussion and self-reported effects on smoking behaviors. We performed up to two successive semi-structured interviews to assess the experiences of 39 individuals who formerly or currently smoked cigarettes who underwent LCS decision-making discussions performed during routine care from three established US medical center LCS programs. The majority of those who remembered hearing about the importance of smoking cessation after LCS-related encounters did not report communication about smoking influencing their motivation to quit or abstain from smoking, including patients who were found to have pulmonary nodules. Patients experienced little distress related to LCS discussions. Patients reported that there were other, more significant, reasons for quitting or abstinence. They recommended clinicians continue to ask about smoking at every clinical encounter, provide information comparing the benefits of LCS with those of quitting smoking, and have clinicians help them identify triggers or other motivators for improving smoking behaviors. Our findings suggest that there may be other teachable moment opportunities outside of LCS processes that could be utilized to motivate smoking reduction or cessation, or LCS processes could be improved to integrate cessation resources.
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Affiliation(s)
- Sara E. Golden
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA,Corresponding author at: 3710 SW US Veterans Hospital Rd. R&D 66, Portland, OR 97239, USA.
| | - Liana Schweiger
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Anne C Melzer
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA,Division of Pulmonary, Allergy, Critical Care and Sleep, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Sarah S. Ono
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA,Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Santanu Datta
- Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - James M. Davis
- Duke Cancer Institute, Duke University, Durham, NC, USA,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Christopher G. Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA,Department of Medicine, Oregon Health & Science University, Portland, OR, USA,Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System, Portland, OR, USA
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Hao L, Liu Y, Dong ZQ, Yi JH, Wang D, Xin L, Guo HL, He L, Bi YW, Ji JT, Wang T, Du TT, Lin JH, Zhang D, Zeng XP, Zou WB, Chen H, Pan J, Liao Z, Xu GQ, Li ZS, Hu LH. Clinical characteristics of smoking-related chronic pancreatitis. Front Cell Infect Microbiol 2022; 12:939910. [PMID: 36061871 PMCID: PMC9433580 DOI: 10.3389/fcimb.2022.939910] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022] Open
Abstract
Objective The pathogenesis of chronic pancreatitis (CP) is not completely clear. With further studies, smoking is toxic to the pancreas. This study classified smoking-related CP as a new etiology of CP and defined the cutoff of smoking. Design Patients with CP admitted from January 2000 to December 2013 were included in the study. The characteristics were compared between smoking patients, drinking patients, and a group of patients who never smoke or drink (control group). The cumulative rates of steatorrhea, diabetes mellitus (DM), pancreatic pseudocyst (PPC), pancreatic stone, and biliary stricture after the onset of CP were calculated, respectively. Results A total of 1,324 patients were included. Among them, 55 were smoking patients, 80 were drinking patients, and 1,189 were controls. The characteristics of smokers are different from the other two groups, especially in age at the onset and diagnosis of CP, initial manifestation, and type of pain. The development of DM (P = 0.011) and PPC (P = 0.033) was significantly more common and earlier in the smokers than in the other two groups. Steatorrhea also developed significantly more in the smokers than in the controls (P = 0.029). Smokers tend to delay the formation of pancreatic stones and steatorrhea. Conclusion The clinical characteristics of smoking-related CP is different from CP of other etiologies. A new type of CP, smoking-related CP, was put forward. Smoking-related CP should be separated from idiopathic CP and defined as a new independent subtype of CP different from alcoholic CP or idiopathic CP.
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Affiliation(s)
- Lu Hao
- Department of Gastroenterology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Yu Liu
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
- Department of Gastroenterology and Hepatology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhi-Qi Dong
- Department of Gastroenterology, Shanghai Fourth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jin-Hui Yi
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Dan Wang
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Lei Xin
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Hong-Lei Guo
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Lin He
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
- Department of Gastroenterology and Endocrinology, 969th Hospital of People's Liberation Army (PLA), Hohhot, China
| | - Ya-Wei Bi
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
- Department of Gastroenterology and Hepatology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Jun-Tao Ji
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
- Shanghai Guangming Middle School, Shanghai, China
| | - Teng Wang
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Ting-Ting Du
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Jin-Huan Lin
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Di Zhang
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Xiang-Peng Zeng
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
- Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fuzhou, China
| | - Wen-Bin Zou
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Hui Chen
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Jun Pan
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Zhuan Liao
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Guo-Qiang Xu
- Department of Gastroenterology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Guo-Qiang Xu, ; Zhao-Shen Li, ; Liang-Hao Hu,
| | - Zhao-Shen Li
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
- *Correspondence: Guo-Qiang Xu, ; Zhao-Shen Li, ; Liang-Hao Hu,
| | - Liang-Hao Hu
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
- *Correspondence: Guo-Qiang Xu, ; Zhao-Shen Li, ; Liang-Hao Hu,
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Ostroff JS, Shelley DR, Chichester LA, King JC, Li Y, Schofield E, Ciupek A, Criswell A, Acharya R, Banerjee SC, Elkin EB, Lynch K, Weiner BJ, Orlow I, Martin CM, Chan SV, Frederico V, Camille P, Holland S, Kenney J. Study protocol of a multiphase optimization strategy trial (MOST) for delivery of smoking cessation treatment in lung cancer screening settings. Trials 2022; 23:664. [PMID: 35978334 PMCID: PMC9383667 DOI: 10.1186/s13063-022-06568-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is widespread agreement that the integration of cessation services in lung cancer screening (LCS) is essential for achieving the full benefits of LCS with low-dose computed tomography (LDCT). There is a formidable knowledge gap about how to best design feasible, effective, and scalable cessation services in LCS facilities. A collective of NCI-funded clinical trials addressing this gap is the Smoking Cessation at Lung Examination (SCALE) Collaboration. METHODS The Cessation and Screening to Save Lives (CASTL) trial seeks to advance knowledge about the reach, effectiveness, and implementation of tobacco treatment in lung cancer screening. We describe the rationale, design, evaluation plan, and interventions tested in this multiphase optimization strategy trial (MOST). A total of 1152 screening-eligible current smokers are being recruited from 18 LCS sites (n = 64/site) in both academic and community settings across the USA. Participants receive enhanced standard care (cessation advice and referral to the national Quitline) and are randomized to receive additional tobacco treatment components (motivational counseling, nicotine replacement patches/lozenges, message framing). The primary outcome is biochemically validated, abstinence at 6 months follow-up. Secondary outcomes are self-reported smoking abstinence, quit attempts, and smoking reduction at 3 and 6 months. Guided by the Implementation Outcomes Framework (IOF), our evaluation includes measurement of implementation processes (reach, fidelity, acceptability, appropriateness, sustainability, and cost). CONCLUSION We will identify effective treatment components for delivery by LCS sites. The findings will guide the assembly of an optimized smoking cessation package that achieves superior cessation outcomes. Future trials can examine the strategies for wider implementation of tobacco treatment in LDCT-LCS sites. TRIAL REGISTRATION ClinicalTrials.gov NCT03315910.
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Affiliation(s)
- Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA.
| | - Donna R Shelley
- School of Global Public Health, New York University, New York, USA
| | - Lou-Anne Chichester
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | | | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Andrew Ciupek
- GO2 Foundation for Lung Cancer, Washington, D.C., USA
| | | | | | - Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Elena B Elkin
- Department of Health Policy and Management, Columbia Mailman School of Public Health, New York, USA
| | - Kathleen Lynch
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, USA
| | - Irene Orlow
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Chloé M Martin
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Sharon V Chan
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Victoria Frederico
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Phillip Camille
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Susan Holland
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Jessica Kenney
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
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12
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Bold KW, Cannon S, Ford BB, Neveu S, Sather P, Toll BA, Fucito LM. Examining Tobacco Treatment Perceptions and Barriers among Black versus Non-Black Adults Attending Lung Cancer Screening. Cancer Prev Res (Phila) 2022; 15:327-333. [PMID: 35063942 PMCID: PMC9064926 DOI: 10.1158/1940-6207.capr-21-0398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/05/2021] [Accepted: 01/18/2022] [Indexed: 11/16/2022]
Abstract
The US Preventive Services Task Force recommends annual lung cancer screening for patients at high risk based on age and smoking history. Understanding the characteristics of patients attending lung cancer screening, including potential barriers to quitting smoking, may inform ways to engage these high-risk patients in tobacco treatment and address health disparities. Patients attending lung cancer screening who currently smoke cigarettes completed a survey at Smilow Cancer Hospital at Yale-New Haven (N = 74) and the Medical University of South Carolina (N = 73) at the time of their appointment. The survey assessed demographics, smoking history, and perceptions and concerns about quitting smoking. Patients were 55 to 76 years old (mean = 63.3, SD = 5.3), N = 64 (43.5%) female, and N = 31 (21.1%) non-Hispanic Black. Patients smoked 16.3 cigarettes per day on average (SD = 9.2) and rated interest in quitting smoking in the next month as moderate (mean = 5.6, SD = 3.1, measured from 0 = "very definitely no" to 10 = "very definitely yes"). The most frequently endorsed concerns about quitting smoking were missing smoking (70.7%), worry about having strong urges to smoke (63.9%), and concerns about withdrawal symptoms (59.9%). In comparison with other races/ethnicities, Black patients were less likely to report concerns about withdrawal symptoms and more likely to report smoking less now and perceiving no need to quit. Findings identified specific barriers for tobacco treatment and differences by race/ethnicity among patients attending lung cancer screening, including concerns about withdrawal symptoms and perceived need to quit. Identifying ways to promote tobacco treatment is important for reducing morbidity and mortality among this high-risk population. PREVENTION RELEVANCE The current study examines patient characteristics and tobacco treatment perceptions and barriers among patients attending lung cancer screening who continue to smoke cigarettes that may help inform ways to increase treatment engagement and address tobacco-related health disparities to reduce morbidity and mortality from smoking.
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Affiliation(s)
- Krysten W Bold
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Sydney Cannon
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Bennie B Ford
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Susan Neveu
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Polly Sather
- Department of Internal Medicine, Section of Pulmonary, Critical Care & Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Benjamin A Toll
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Lisa M Fucito
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut
- Smilow Cancer Hospital at Yale-New Haven, New Haven, Connecticut
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13
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Likely uptake of a future a lung cancer screening programme in Hodgkin lymphoma survivors: a questionnaire study. BMC Pulm Med 2022; 22:165. [PMID: 35484621 PMCID: PMC9052526 DOI: 10.1186/s12890-022-01959-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background Many Hodgkin lymphoma (HL) survivors are at increased risk of subsequent malignant neoplasms (SMN), including lung cancer, due to previous treatment for HL. Lung cancer screening (LCS) detects early-stage lung cancers in ever smokers but HL survivors without a heavy smoking history are ineligible for screening. There is a rationale to develop a targeted LCS. The aim of this study was to investigate levels of willingness to undergo LCS in HL survivors, and to identify the psycho-social factors associated with screening hesitancy. Methods A postal questionnaire was sent to 281 HL survivors registered in a long-term follow-up database and at increased risk of SMNs. Demographic, lung cancer risk factors, psycho-social and LCS belief variables were measured. Multivariable logistic regression analysis was performed to determine the factors associated with lung cancer screening hesitancy, defined as those who would ‘probably’ or ‘probably not’ participate. Results The response rate to the questionnaire was 58% (n = 165). Participants were more likely to be female, older and living in a less deprived area than non-participants. Uptake (at any time) of breast and bowel cancer screening among those previously invited was 99% and 77% respectively. 159 participants were at excess risk of lung cancer. The following results refer to these 159. Around half perceived themselves to be at greater risk of lung cancer than their peers. Only 6% were eligible for lung cancer screening pilots aimed at ever smokers in the UK. 98% indicated they would probably or definitely participate in LCS were it available. Psycho-social variables associated with LCS hesitancy on multivariable analysis were male gender (OR 5.94 CI 1.64–21.44, p < 0.01), living in an area with a high index of multiple deprivation decile (deciles 6–10) (OR 8.22 CI 1.59–42.58, p < 0.05) and lower levels of self-efficacy (OR 1.64 CI 1.30–2.08 p < 0.01). Conclusion HL survivors responding to this survey were willing to participate in a future LCS programme but there was some hesitancy. A future LCS trial for HL survivors should consider the factors associated with screening hesitancy in order to minimise barriers to participation. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01959-3.
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14
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Williams RM, Cordon M, Eyestone E, Smith L, Luta G, McKee BJ, Regis SM, Abrams DB, Niaura RS, Stanton CA, Parikh V, Taylor KL. Improved motivation and readiness to quit shortly after lung cancer screening: Evidence for a teachable moment. Cancer 2022; 128:1976-1986. [PMID: 35143041 PMCID: PMC9038674 DOI: 10.1002/cncr.34133] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND For patients at high risk for lung cancer, screening using low-dose computed tomography (lung cancer screening [LCS]) is recommended. The purpose of this study was to examine whether screening may serve as a teachable moment for smoking-related outcomes. METHODS In a smoking-cessation trial, participants (N = 843) completed 2 phone interviews before randomization: before LCS (T0) and after LCS (T1). By using logistic and linear regression, the authors examined teachable moment variables (perceived risk, lung cancer worry) and outcomes (readiness, motivation, and cigarettes per day [CPD]). RESULTS Participants were a mean ± SD age of 63.7 ± 5.9 years, had 47.8 ± 7.1 pack-years of smoking, 35.2% had a high school diploma or General Educational Development (high school equivalency) degree or less, and 42.3% were undergoing their first scan. Between T0 and T1, 25.7% of participants increased readiness to quit, 9.6% decreased readiness, and 64.7% reported no change (P < .001). Motivation to quit increased (P < .05) and CPD decreased between assessments (P < .001), but only 1.3% self-reported quitting. Compared with individuals who reported no lung cancer worry/little worry, extreme worry was associated with readiness to quit in the next 30 days (odds ratio, 1.8; 95% CI, 1.1-3.0) and with higher motivation (b = 0.83; P < .001) at T1. Individuals undergoing a baseline (vs annual) scan were more ready to quit in the next 30 days (odds ratio, 1.8; 95% CI, 1.3-2.5). CONCLUSIONS During the brief window between registering for LCS and receiving the results, the authors observed that very few participants quit smoking, but a significant proportion improved on readiness and motivation to quit, particularly among individuals who were undergoing their first scan and those who were extremely worried about lung cancer. These results indicate that providing evidence-based tobacco treatment can build upon this teachable moment.
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Affiliation(s)
- Randi M Williams
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - Marisa Cordon
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - Ellie Eyestone
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - Laney Smith
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - George Luta
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, District of Columbia
| | - Brady J McKee
- Division of Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Shawn M Regis
- Division of Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - David B Abrams
- New York University School of Global Public Health, New York, New York
| | - Raymond S Niaura
- New York University School of Global Public Health, New York, New York
| | | | - Vicky Parikh
- Department of Population Health, MedStar Shah Medical Group, Hollywood, Maryland
| | - Kathryn L Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
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15
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Baggett TP, Barbosa Teixeira J, Rodriguez EC, Anandakugan N, Sporn N, Chang Y, Percac-Lima S, Park ER, Rigotti NA. Patient navigation to promote lung cancer screening in a community health center for people experiencing homelessness: Protocol for a pragmatic randomized controlled trial. Contemp Clin Trials 2022; 113:106666. [PMID: 34971796 DOI: 10.1016/j.cct.2021.106666] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/13/2021] [Accepted: 12/23/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Lung cancer is a major cause of death among people experiencing homelessness, with mortality rates more than double those in the general population. Lung cancer screening (LCS) with low-dose computed tomography (LDCT) could reduce lung cancer deaths in this population, although the circumstances of homelessness present multiple barriers to LCS LDCT completion. Patient navigation is a promising strategy for overcoming these barriers. METHODS The Investigating Navigation to Help Advance Lung Equity (INHALE) Study is a pragmatic randomized controlled trial of patient navigation for LCS among individuals receiving primary care at Boston Health Care for the Homeless Program (BHCHP). Three hundred BHCHP patients who meet Medicare/Medicaid criteria for LCS will be randomized 2:1 to usual care with (n = 200) or without (n = 100) LCS navigation. Following a structured, theory-based protocol, the patient navigator assists with each step in the LCS process, providing lung cancer education, facilitating shared decision-making visits with primary care providers (PCPs), assisting in making and attending LCS LDCT appointments, arranging follow-up when needed, and offering tobacco cessation support for smokers. The primary outcome is receipt of LCS LDCT at 6 months. Using a sequential explanatory mixed methods approach, qualitative interviews with participants and PCPs will aid in interpreting and contextualizing the trial results. DISCUSSION This trial will produce the first experimental evidence on patient navigation for cancer screening in a homeless health care setting. Results could inform cancer health equity efforts at the 299 Health Care for the Homeless programs that serve over 900,000 patients annually in the US.
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Affiliation(s)
- Travis P Baggett
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America; Institute for Research, Quality & Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, MA, United States of America.
| | - Joana Barbosa Teixeira
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Elijah C Rodriguez
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; New York University Grossman School of Medicine, New York, NY, United States of America
| | - Nillani Anandakugan
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Nora Sporn
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Yuchiao Chang
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Sanja Percac-Lima
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Elyse R Park
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Nancy A Rigotti
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
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16
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Liu X, Zhou Y, Wang Z. Preference access of users' cancer risk perception using disease-specific online medical inquiry texts. Inf Process Manag 2022. [DOI: 10.1016/j.ipm.2021.102737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Quaife SL, Waller J, Dickson JL, Brain KE, Kurtidu C, McCabe J, Hackshaw A, Duffy SW, Janes SM. Psychological Targets for Lung Cancer Screening Uptake: A Prospective Longitudinal Cohort Study. J Thorac Oncol 2021; 16:2016-2028. [PMID: 34403828 DOI: 10.1016/j.jtho.2021.07.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/26/2021] [Accepted: 07/30/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Low uptake of low-dose computed tomography lung cancer screening by high-risk groups compromises its effectiveness and equity as a population-level early detection strategy. Numerous psychological factors are implicated qualitatively or retrospectively, but prospective data are needed to validate their associations with uptake behavior and specify psychological targets for intervention. METHODS This is a prospective, longitudinal cohort study evaluating psychological correlates of lung cancer screening uptake. Ever-smokers (aged 55-77 y) were invited to a lung health check, at which low-dose computed tomography screening was offered through the SUMMIT Study-a multicenter screening implementation trial. One week after their screening invitation, 44,000 invitees were mailed the self-regulatory questionnaire for lung cancer screening. Regression analyses evaluated the constructs' associations with uptake (telephoning for an appointment) and sociodemographic characteristics. RESULTS Higher odds of uptake were associated with both positive and negative perceptions. Positive perceptions included lung cancer controllability, benefits of early diagnosis, improved survival when lung cancer is detected early, willingness to be treated, and believing smoking cessation is effective in reducing risk. Negative perceptions included a higher lung cancer risk perception, negative beliefs about the consequences of lung cancer, perceiving lung cancer as stigmatized, and a negative emotional response. Although current smokers held the highest risk perceptions, they also reported negative perceptions that could undermine how they behave in response to their risk. CONCLUSIONS Interventions to improve uptake should focus on changing perceptions that affect how an individual reacts when they believe their risk of lung cancer is high.
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Affiliation(s)
- Samantha L Quaife
- Wolfson Institute of Population Health, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
| | - Jo Waller
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Jennifer L Dickson
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, United Kingdom
| | - Kate E Brain
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Clara Kurtidu
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - John McCabe
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, United Kingdom
| | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, Cancer Institute, University College London, London, United Kingdom
| | - Stephen W Duffy
- Wolfson Institute of Population Health, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Samuel M Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, United Kingdom
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Neil JM, Marotta C, Gonzalez I, Chang Y, Levy DE, Wint A, Harris K, Hawari S, Noonan E, Styklunas G, Crute S, Howard SE, Sheppard J, Lennes IT, Jacobson F, Flores EJ, Haas JS, Park ER, Rigotti NA. Integrating tobacco treatment into lung cancer screening practices: Study protocol for the Screen ASSIST randomized clinical trial. Contemp Clin Trials 2021; 111:106586. [PMID: 34606988 PMCID: PMC8874354 DOI: 10.1016/j.cct.2021.106586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Integrating tobacco treatment services into lung cancer screening (LCS) has the potential to leverage a 'teachable moment' to promote cessation among long-term smokers and reduce disparities in tobacco treatment access. This protocol paper describes the Screen ASSIST (Aiding Screening Support In Stopping Tobacco) trial, which will identify how to best deliver evidence-driven tobacco treatment in the context of LCS. METHODS Screen ASSIST is a randomized clinical trial with a 3-factor, fully crossed factorial design that enrolls current smokers (any cigarette use in the past 30 days) scheduled to attend LCS at multiple sites in the Mass General Brigham healthcare system. To maximize reach, recruitment is conducted at 3 time points: 1) at the time of LCS scheduling, 2) at the LCS visit, and 3) after the participant has received their LCS results. Participants are stratified by LCS study site and recruitment point and randomly assigned into 8 groups that test intervention components varying on telehealth counseling duration (4 weeks vs. 8 weeks), nicotine replacement therapy duration (2 weeks vs. 8 weeks), and systematic screening and referral for social determinants of health via a service named 'AuntBertha' (referral vs. no referral). The primary study outcome is self-reported past 7-day tobacco abstinence at 6-month follow-up. This trial will also assess systems integration and evaluate implementation of the intervention. DISCUSSION Screen ASSIST will identify the most effective combination of tobacco cessation treatments within the LCS context, in order to improve the cost-effectiveness of LCS and quality of life among long-term heavy smokers.
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Affiliation(s)
- Jordan M Neil
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America; TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States of America; Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - Caylin Marotta
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Irina Gonzalez
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Yuchiao Chang
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Douglas E Levy
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Amy Wint
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Kimberly Harris
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Saif Hawari
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Elise Noonan
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Grace Styklunas
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Sydney Crute
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Sydney E Howard
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Joanne Sheppard
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Inga T Lennes
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Francine Jacobson
- Department of Radiology, Brigham and Women's Faulkner Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Efren J Flores
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Jennifer S Haas
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Elyse R Park
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Nancy A Rigotti
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
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19
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Broadbent R, Gorman L, Armitage CJ, Radford J, Linton K. The perspectives of survivors of Hodgkin lymphoma on lung cancer screening: A qualitative study. Health Expect 2021; 25:116-124. [PMID: 34755419 DOI: 10.1111/hex.13353] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/21/2021] [Accepted: 08/12/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Hodgkin lymphoma survivors (HLS) are at excess risk of lung cancer as a consequence of HL treatment. HLS without a heavy smoking history are currently unable to access lung cancer screening (LCS) programmes aimed at ever smokers, and there is an unmet need to develop a targeted LCS programme. In this study we prospectively explored HLS perspectives on a future LCS programme, including motivating factors and potential barriers to participation, with the aim of identifying ways to optimise uptake in a future programme. METHODS Semistructured telephone interviews were conducted with HLS, aged 18-80 and lymphoma-free for ≥5 years, selected from a clinical database (ADAPT). Participants provided informed consent. Data were analysed using inductive thematic analysis. RESULTS Despite awareness of other late effects, most participants were unaware of their excess risk of lung cancer. Most were willing to participate in a future LCS programme, citing the potential curability of early-stage lung cancer and reassurance as motivating factors, whilst prior experience of healthcare was a facilitator. Whilst the screening test (a low dose CT scan) was considered acceptable, radiation risk was a concern for some and travel and time off work were potential barriers to participation. CONCLUSIONS Our results suggest that most HLS would participate in a future LCS programme, motivated by perceived benefits. Their feedback identified a need to develop educational materials addressing lung cancer risk and concerns about screening, including radiation risk. Such materials could be provided upon an invitation to LCS. Uptake in a future programme may be further optimized by offering flexible screening appointments close to home.
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Affiliation(s)
- Rachel Broadbent
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK.,The Christie NHS Foundation Trust, Manchester, UK
| | - Louise Gorman
- NIHR Greater Manchester Patient Safety Translational Research Centre, Centre for Mental Health and Safety, Division of Population Health, Health Services Research & Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Christopher J Armitage
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK.,Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - John Radford
- Manchester Cancer Research Centre, Manchester, UK
| | - Kim Linton
- Manchester Cancer Research Centre, Manchester, UK
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20
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Deros DE, Hagerman CJ, Kramer JA, Anderson ED, Regis S, McKee AB, McKee BJ, Stanton CA, Niaura R, Abrams DB, Ramsaier M, Fallon S, Harper H, Taylor KL. Change in amount smoked and readiness to quit among patients undergoing lung cancer screening. J Thorac Dis 2021; 13:4947-4955. [PMID: 34527333 PMCID: PMC8411192 DOI: 10.21037/jtd-20-3267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/13/2021] [Indexed: 11/06/2022]
Abstract
Background There is mixed evidence regarding whether undergoing computed tomography lung cancer screening (LCS) can serve as a "teachable moment" that impacts smoking behavior and attitudes. The study aim was to assess whether the standard procedures of undergoing LCS and receiving free and low-cost evidence-based cessation resources impacted short-term smoking-related outcomes. Methods Participants were smokers (N=87) who were registered to undergo lung screening and were enrolled in a cessation intervention trial. We conducted two phone interviews, both preceding trial randomization: the first interview was conducted prior to lung screening, and the second interview followed lung screening (median =12.5 days post-screening) and participants' receipt of their screening results. The interviews assessed demographic characteristics, interest in evidence-based cessation intervention methods, and tobacco-related characteristics, including cigarettes per day and readiness to quit. Participants received minimal evidence-based cessation resources following the pre-lung screening interview. Results Participants were 60.3 years old, 56.3% female, and reported a median of 40 pack-years. Participants were interested in using several evidence-based strategies, including counseling from a healthcare provider (76.7%) and receiving nicotine replacement therapy (69.8%). Pre-lung screening, 25.3% smoked ≤10 cigarettes per day, and 29.9% were ready to quit in the next 30 days. We conducted two McNemar binomial distribution tests to assess change from pre- to post-screening. At the post-lung screening assessment, approximately three-quarters reported no change on these variables. However, 23.3% reported smoking fewer cigarettes per day, whereas 4.7% reported smoking more cigarettes per day (McNemar P=0.002), and 17.2% reported increased readiness to quit, whereas 6.9% reported decreased readiness to quit (McNemar P=0.078). Conclusions Following receipt of cessation resources and completion of lung screening, most participants reported no change in smoking outcomes. However, there was a significant reduction in cigarettes per day, and there was a trend for increased readiness to quit. This setting may provide a potential "teachable moment" and an opportunity to assist smokers with quitting. However, more proactive and intensive interventions will be necessary to capitalize on these changes and to support abstinence in the long-term.
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Affiliation(s)
- Danielle E Deros
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Charlotte J Hagerman
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Jenna A Kramer
- Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC, USA
| | - Eric D Anderson
- Medstar Georgetown University Medical Center, Washington, DC, USA
| | - Shawn Regis
- Sophia Gordon Cancer Center, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Andrea B McKee
- Sophia Gordon Cancer Center, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Brady J McKee
- Sophia Gordon Cancer Center, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Cassandra A Stanton
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.,Westat, Inc. Rockville, MD, USA
| | - Ray Niaura
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.,Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY, USA
| | - David B Abrams
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.,Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY, USA
| | - Michael Ramsaier
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Shelby Fallon
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Harry Harper
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Kathryn L Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
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21
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Neil JM, Chang Y, Goshe B, Rigotti N, Gonzalez I, Hawari S, Ballini L, Haas JS, Marotta C, Wint A, Harris K, Crute S, Flores E, Park ER. A Web-Based Intervention to Increase Smokers' Intentions to Participate in a Cessation Study Offered at the Point of Lung Screening: Factorial Randomized Trial. JMIR Form Res 2021; 5:e28952. [PMID: 34255651 PMCID: PMC8280830 DOI: 10.2196/28952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/25/2021] [Accepted: 05/16/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Screen ASSIST is a cessation trial offered to current smokers at the point of lung cancer screening. Because of the unique position of promoting a prevention behavior (smoking cessation) within the context of a detection behavior (lung cancer screening), this study employed prospect theory to design and formatively evaluate a targeted recruitment video prior to trial launch. OBJECTIVE The aim of this study was to identify which message frames were most effective at promoting intent to participate in a smoking cessation study. METHODS Participants were recruited from a proprietary opt-in online panel company and randomized to a 2 (benefits of quitting vs risks of continuing to smoke at the time of lung screening; BvR) × 2 (gains of participating vs losses of not participating in a cessation study; GvL) message design experiment (N=314). The primary outcome was self-assessed intent to participate in a smoking cessation study. Message effectiveness and lung cancer risk perception measures were also collected. Analysis of variance examined the main effect of the 2 message factors and a least absolute shrinkage and selection operator (LASSO) approach identified predictors of intent to participate in a multivariable model. A mediation analysis was conducted to determine the direct and indirect effects of message factors on intent to participate in a cessation study. RESULTS A total of 296 participants completed the intervention. There were no significant differences in intent to participate in a smoking cessation study between message frames (P=.12 and P=.61). In the multivariable model, quit importance (P<.001), perceived message relevance (P<.001), and affective risk response (ie, worry about developing lung cancer; P<.001) were significant predictors of intent to participate. The benefits of quitting frame significantly increased affective risk response (Meanbenefits 2.60 vs Meanrisk 2.40; P=.03), which mediated the relationship between message frame and intent to participate (b=0.24; 95% CI 0.01-0.47; P=.03). CONCLUSIONS This study provides theoretical and practical guidance on how to design and evaluate proactive recruitment messages for a cessation trial. Based on our findings, we conclude that heavy smokers are more responsive to recruitment messages that frame the benefits of quitting as it increased affective risk response, which predicted greater intention to participate in a smoking cessation study.
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Affiliation(s)
- Jordan M Neil
- Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Yuchiao Chang
- Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Brett Goshe
- Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Nancy Rigotti
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Irina Gonzalez
- Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Saif Hawari
- Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Lauren Ballini
- Department of Community Health, Tufts University, Medford, MA, United States
| | - Jennifer S Haas
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Caylin Marotta
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Amy Wint
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Kim Harris
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sydney Crute
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Efren Flores
- Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Elyse R Park
- Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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22
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Rankin NM, McWilliams A, Marshall HM. Lung cancer screening implementation: Complexities and priorities. Respirology 2021; 25 Suppl 2:5-23. [PMID: 33200529 DOI: 10.1111/resp.13963] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/17/2022]
Abstract
Lung cancer is the number one cause of cancer death worldwide. The benefits of lung cancer screening to reduce mortality and detect early-stage disease are no longer in any doubt based on the results of two landmark trials using LDCT. Lung cancer screening has been implemented in the US and South Korea and is under consideration by other communities. Successful translation of demonstrated research outcomes into the routine clinical setting requires careful implementation and co-ordinated input from multiple stakeholders. Implementation aspects may be specific to different healthcare settings. Important knowledge gaps remain, which must be addressed in order to optimize screening benefits and minimize screening harms. Lung cancer screening differs from all other cancer screening programmes as lung cancer risk is driven by smoking, a highly stigmatized behaviour. Stigma, along with other factors, can impact smokers' engagement with screening, meaning that smokers are generally 'hard to reach'. This review considers critical points along the patient journey. The first steps include selecting a risk threshold at which to screen, successfully engaging the target population and maximizing screening uptake. We review barriers to smoker engagement in lung and other cancer screening programmes. Recruitment strategies used in trials and real-world (clinical) programmes and associated screening uptake are reviewed. To aid cross-study comparisons, we propose a standardized nomenclature for recording and calculating recruitment outcomes. Once participants have engaged with the screening programme, we discuss programme components that are critical to maximize net benefit. A whole-of-programme approach is required including a standardized and multidisciplinary approach to pulmonary nodule management, incorporating probabilistic nodule risk assessment and longitudinal volumetric analysis, to reduce unnecessary downstream investigations and surgery; the integration of smoking cessation; and identification and intervention for other tobacco related diseases, such as coronary artery calcification and chronic obstructive pulmonary disease. National support, integrated with tobacco control programmes, and with appropriate funding, accreditation, data collection, quality assurance and reporting mechanisms will enhance lung cancer screening programme success and reduce the risks associated with opportunistic, ad hoc screening. Finally, implementation research must play a greater role in informing policy change about targeted LDCT screening programmes.
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Affiliation(s)
- Nicole M Rankin
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Annette McWilliams
- Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, WA, Australia.,Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia.,Thoracic Tumour Collaborative of Western Australia, Western Australia Cancer and Palliative Care Network, Perth, WA, Australia
| | - Henry M Marshall
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia.,The University of Queensland Thoracic Research Centre, Brisbane, QLD, Australia
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23
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Quaife SL, Janes SM, Brain KE. The person behind the nodule: a narrative review of the psychological impact of lung cancer screening. Transl Lung Cancer Res 2021; 10:2427-2440. [PMID: 34164290 PMCID: PMC8182717 DOI: 10.21037/tlcr-20-1179] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/12/2021] [Indexed: 12/28/2022]
Abstract
Lung cancer is the leading cause of cancer mortality globally, responsible for an estimated 1.76 million deaths worldwide in 2018 alone. Screening adults at high risk of lung cancer using low-dose computed tomography (LDCT) significantly reduces lung cancer mortality by finding the disease at an early, treatable stage. Many countries are actively considering whether to implement screening for their high-risk populations in light of the recently published Dutch-Belgian trial 'NELSON'. In deciding whether to implement a national screening programme, policymakers must weigh up the evidence for the relative risks posed to the entire screened population, including the potential psychological burden. This narrative review aimed to critically summarise the evidence for both negative and positive psychological responses experienced throughout the LDCT screening pathway, to describe their magnitude, duration and clinical relevance, and to draw out different aspects of measurement design crucial to their interpretation. A further aim was to discuss the available evidence for individual differences in psychological response, as well as interventions designed to promote psychological well-being. In summary, there was no evidence that the LDCT screening process caused adverse psychological outcomes overall, although those receiving indeterminate and suspicious LDCT results did report clinically raised anxiety and lung cancer-specific distress in the short-term. There was early evidence that demographic factors, smoking status and screening-ineligibility could be associated with individual differences in propensity to experience distress. Qualitative data suggested health beliefs could be modifiable mediators of these individual differences, but their aetiology requires quantitative and prospective research. There was also some evidence of positive psychological responses that could be capitalised on, and of the potential for person-centred communication interventions to achieve this. Further research needs to be embedded in real-world LDCT lung cancer screening services and use condition-specific measures to monitor outcomes and test evidence-based communication interventions in promoting psychological well-being.
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Affiliation(s)
- Samantha L. Quaife
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Samuel M. Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, UK
| | - Kate E. Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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24
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Turner J, Pond GR, Tremblay A, Johnston M, Goss G, Nicholas G, Martel S, Bhatia R, Liu G, Schmidt H, Tammemagi MC, Puksa S, Atkar-Khattra S, Tsao MS, Lam S, Goffin JR. Risk Perception Among a Lung Cancer Screening Population. Chest 2021; 160:718-730. [PMID: 33667493 DOI: 10.1016/j.chest.2021.02.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 01/28/2021] [Accepted: 02/03/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A successful lung cancer screening program requires a patient cohort at sufficient risk of developing cancer who are willing to participate. Among other factors, a patient's lung cancer risk perception may inform their attitudes toward screening and smoking cessation programs. RESEARCH QUESTION This study analyzed data from the Pan-Canadian Early Detection of Lung Cancer (PanCan) Study to address the following questions: Which factors are associated with the perception of lung cancer risk? Is there an association between risk perception for lung cancer and actual calculated risk? Is there an association between risk perception for lung cancer and the intent to quit smoking? Are there potential targets for lung cancer screening awareness? STUDY DESIGN AND METHODS The PanCan study recruited current or former smokers aged 50 to 75 years who had at least a 2% risk of developing lung cancer over 6 years to undergo low-dose screening CT. Risk perception and worry about lung cancer were captured on a baseline questionnaire. Cumulative logistic regression analysis was used to assess the relationship between baseline risk variables and both lung cancer risk perception and worry. RESULTS Among the 2,514 individuals analyzed, a higher perceived risk of lung cancer was positively associated with calculated risk (P = .032). Younger age, being a former smoker, respiratory symptoms, lower FEV1, COPD, and a family history of lung cancer were associated with higher perceived risk. Conversely, a consistent relationship between calculated risk and worry was not identified. There was a positive association between risk perception and lung cancer worry and reported intent to quit smoking. INTERPRETATION Individuals' lung cancer risk perception correlated positively with calculated risk in a screening population. Promotion of screening programs may benefit from focusing on factors associated with higher risk perception; conversely, harnessing worry seemingly holds less value.
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Affiliation(s)
| | | | | | | | - Glen Goss
- University of Ottawa, Ottawa, ON, Canada
| | | | - Simon Martel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, Québec, QC, Canada
| | | | - Geoffrey Liu
- University Health Network and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Heidi Schmidt
- University Health Network and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | - Ming-Sound Tsao
- University Health Network and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Stephen Lam
- British Columbia Cancer Agency, Vancouver, BC, Canada
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25
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Hillyer GC, Mapanga W, Jacobson JS, Graham A, Mmoledi K, Makhutle R, Osei-Fofie D, Mulowayi M, Masuabi B, Bulman WA, Neugut AI, Joffe M. Attitudes toward tobacco cessation and lung cancer screening in two South African communities. Glob Public Health 2020; 15:1537-1550. [PMID: 32406331 DOI: 10.1080/17441692.2020.1761425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Among men in South Africa, the prevalence of tobacco smoking is as high as 33%. Although smoking is responsible for most lung cancer in South Africa, occupational and environmental exposures contribute greatly to risk. We conducted a tobacco and lung cancer screening needs assessment and administered surveys to adults who smoked >100 cigarettes in their lifetime in Johannesburg (urban) and Kimberley (rural). We compared tobacco use, risk exposure, attitudes toward and knowledge of, and receptivity to cessation and screening, by site. Of 324 smokers, nearly 85% of current smokers had a <30 pack-year history of smoking; 58.7% had tried to stop smoking ≥1 time, and 78.9% wanted to quit. Kimberley smokers more often reported being advised by a healthcare provider to stop smoking (56.5% vs. 37.3%, p=0.001) than smokers in Johannesburg but smokers in Johannesburg were more willing to stop smoking if advised by their doctor (72.9% vs. 41.7%, p<0.001). Findings indicate that tobacco smokers in two geographic areas of South Africa are motivated to stop smoking but receive no healthcare support to do so. Developing high risk criteria for lung cancer screening and creating tobacco cessation infrastructure may reduce tobacco use and decrease lung cancer mortality in South Africa.
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Affiliation(s)
- Grace C Hillyer
- Mailman School of Public Health, Columbia University, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Witness Mapanga
- Non-Communicable Diseases Research (NCDR) Division of the Wits Health Consortium, University of Witwatersrand, Johannesburg, South Africa
| | - Judith S Jacobson
- Mailman School of Public Health, Columbia University, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Anita Graham
- Non-Communicable Diseases Research (NCDR) Division of the Wits Health Consortium, University of Witwatersrand, Johannesburg, South Africa
| | - Keletso Mmoledi
- Non-Communicable Diseases Research (NCDR) Division of the Wits Health Consortium, University of Witwatersrand, Johannesburg, South Africa
| | - Raynolda Makhutle
- Non-Communicable Diseases Research (NCDR) Division of the Wits Health Consortium, University of Witwatersrand, Johannesburg, South Africa
| | | | | | | | - William A Bulman
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Alfred I Neugut
- Mailman School of Public Health, Columbia University, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA.,Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Maureen Joffe
- Non-Communicable Diseases Research (NCDR) Division of the Wits Health Consortium, University of Witwatersrand, Johannesburg, South Africa
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26
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Golden SE, Ono SS, Melzer A, Davis J, Zeliadt SB, Heffner JL, Kathuria H, Garcia-Alexander G, Slatore CG. "I Already Know That Smoking Ain't Good for Me": Patient and Clinician Perspectives on Lung Cancer Screening Decision-Making Discussions as a Teachable Moment. Chest 2020; 158:1250-1259. [PMID: 32304776 DOI: 10.1016/j.chest.2020.03.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 03/09/2020] [Accepted: 03/19/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Lung cancer screening (LCS) is now recommended for people at high risk of dying of lung cancer. RESEARCH QUESTION The purpose of this study was to use the LCS decision discussion as a case study to understand possible underlying components of a teachable moment to enhance motivation for smoking cessation. STUDY DESIGN AND METHODS The study investigated how patients and clinicians communicate about smoking. In-depth, semi-structured interviews were performed of the experiences of 51 individuals who formerly or currently smoked who were offered LCS and 24 clinicians. Only the baseline interviews were used because including the follow-up interviews would have been beyond the scope of this article. The interviews focused on communication about smoking, the perceived importance of discussing smoking and screening together, and patients' perceived challenges to smoking cessation. RESULTS Patients and clinicians differed in their views on the role of the LCS decision discussion as a teachable moment. Although clinicians felt that this discussion was a good opportunity to positively influence smoking behaviors, neither patients nor clinicians perceived the discussion as a teachable moment affecting smoking behaviors. Other motivating factors for smoking cessation were found. INTERPRETATION Our findings indicate that LCS decision discussions are not currently a teachable moment for behavior change in smoking cessation, but perhaps clinicians could address other aspects of communication to enhance motivation for cessation. Our hypothesized teachable moment model helps explain that there may not be sufficient emotional response elicited during the discussion to motivate a major behavior change such as smoking cessation.
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Affiliation(s)
- Sara E Golden
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Department of Sociology, Portland State University, Portland, OR.
| | - Sarah S Ono
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Anne Melzer
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN; Department of Medicine, University of Minnesota, Minneapolis, MN
| | - James Davis
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Steven B Zeliadt
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA; Department of Health Services, University of Washington, Seattle, WA
| | | | - Hasmeena Kathuria
- The Pulmonary Center, Boston University School of Medicine, Boston, MA
| | | | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System, Portland, OR; Department of Medicine, Oregon Health & Science University, Portland, OR
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27
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Kummer S, Waller J, Ruparel M, Cass J, Janes SM, Quaife SL. Mapping the spectrum of psychological and behavioural responses to low-dose CT lung cancer screening offered within a Lung Health Check. Health Expect 2020; 23:433-441. [PMID: 31961060 PMCID: PMC7104654 DOI: 10.1111/hex.13030] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/19/2019] [Accepted: 01/02/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Research on the psychological impact of low-dose computed tomography (LDCT) lung cancer screening has typically been narrow in scope and restricted to the trial setting. OBJECTIVE To explore the range of psychological and behavioural responses to LDCT screening offered as part of a Lung Heath Check (LHC), including lung cancer risk assessment, spirometry testing, a carbon monoxide reading and smoking cessation advice. METHODS Semi-structured interviews were carried out with 28 current and former smokers (aged 60-75), who had undergone LDCT screening as part of a LHC appointment and mostly received an incidental or indeterminate result (n = 23). Framework analysis was used to map the spectrum of responses participants had across the LHC appointment and screening pathway, to their LDCT results and to surveillance. RESULTS Interviewees reported a diverse range of both positive and negative psychological responses, beginning at invitation and spanning the entire LHC appointment (including spirometry) and LDCT screening pathway. Similarly, positive behavioural responses extended beyond smoking cessation to include anticipated implications for other cancer prevention and early detection behaviours, such as symptom presentation. Individual differences in responses appeared to be influenced by smoking status and LDCT result, as well as modifiable factors including perceived risk and health status, social support, competing priorities, fatalism and perceived stigma. CONCLUSIONS The diverse ways in which participants responded to screening, both psychologically and behaviourally, should direct a broader research agenda to ensure all stages of screening delivery and communication are designed to promote well-being, motivate positive behaviour change and maximize patient benefit.
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Affiliation(s)
- Sonja Kummer
- Research Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Jo Waller
- Research Department of Behavioural Science and HealthUniversity College LondonLondonUK
- School of Cancer & Pharmaceutical SciencesKing’s College LondonLondonUK
| | - Mamta Ruparel
- Lungs for Living Research CentreUCL RespiratoryDivision of MedicineUniversity College LondonLondonUK
| | - Judith Cass
- Lungs for Living Research CentreUCL RespiratoryDivision of MedicineUniversity College LondonLondonUK
| | - Samuel M. Janes
- Lungs for Living Research CentreUCL RespiratoryDivision of MedicineUniversity College LondonLondonUK
| | - Samantha L. Quaife
- Research Department of Behavioural Science and HealthUniversity College LondonLondonUK
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See K, Manser R, Park ER, Steinfort D, King B, Piccolo F, Manners D. The impact of perceived risk, screening eligibility and worry on preference for lung cancer screening: a cross-sectional survey. ERJ Open Res 2020; 6:00158-2019. [PMID: 32201692 PMCID: PMC7073421 DOI: 10.1183/23120541.00158-2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 01/23/2020] [Indexed: 11/05/2022] Open
Abstract
Lung cancer screening is effective at reducing lung cancer deaths when individuals at greatest risk are screened. Recruitment initiatives target all current and former smokers, of whom only some are eligible for screening, potentially leading to discordance between screening preference and eligibility in ineligible individuals. The objective of the present study was to identify factors associated with preference for screening among ever-smokers. Ever-smokers aged 55-80 years attending outpatient clinics at three Australian hospitals were invited. The survey recorded: 1) demographics; 2) objective lung cancer risk and screening eligibility using the Prostate Lung Colon Ovarian 2012 risk model; and 3) perceived lung cancer risk, worry about and seriousness of lung cancer using a validated questionnaire. Multivariable ordinal logistic regression identified predictors of screening preference. The survey was completed by 283 individuals (response rate 27%). Preference for screening was high (72%) with no significant difference between low-dose computed tomography screening-eligible and -ineligible individuals (77% versus 68%, p=0.11). Worry about lung cancer (adjusted-proportional odds ratio (adj-OR) 1.31, 95% CI 1.08-1.58; p=0.007) and perceived seriousness of lung cancer (adj-OR 1.31, 95% CI 1.05-1.64; p=0.02) were associated with higher preference for lung cancer screening while screening eligibility was not. The concept of "early detection" was the most important driver to have screening while practical obstacles like difficulty travelling to the scan or taking time off work were the least important barriers to screening. Most current or former smokers prefer to undergo screening. Worry about lung cancer and perceived seriousness of the diagnosis are more important drivers for screening preference than eligibility status.
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Affiliation(s)
- Katharine See
- Dept of Respiratory Medicine, Northern Hospital, Epping, Victoria, Australia
| | - Renee Manser
- Dept of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Dept of Medicine (Royal Melbourne Hospital), University of Melbourne, Victoria, Australia.,Dept of Medical Oncology and Haematology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Elyse R Park
- Harvard Medical School, Massachusetts General Hosptial, Boston, MA, USA
| | - Daniel Steinfort
- Dept of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Bridget King
- Dept of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Francesco Piccolo
- Midland Physician Service, St John of God Midland Private and Public Hospitals, Midland, Western Australia, Australia
| | - David Manners
- Midland Physician Service, St John of God Midland Private and Public Hospitals, Midland, Western Australia, Australia.,Curtin Medical School, Curtin University, Bentley, Western Australia, Australia
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Kok WH, Ban Yu-Lin A, Azhar Shah S, Abdul Hamid F. Determining the perception of a lung cancer screening programme among high-risk patients in a tertiary referral centre, Kuala Lumpur. PROCEEDINGS OF SINGAPORE HEALTHCARE 2020. [DOI: 10.1177/2010105819891743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Lung cancer is the second most common cause of cancer-related death and the third most common cancer in Malaysia. The rising prevalence of lung cancer suggests the need to consider disease screening for early detection, especially in the high-risk population, as it offers the best chance of cure. Objectives: The study aims to determine the willingness of high-risk respondents to participate in a lung cancer screening programme if made available to them, and to determine their attitude towards lung cancer screening and explore factors that might affect participation in a screening programme. Method: This is a cross-sectional, descriptive study over 6 months conducted in adult patients attending medical clinics in Universiti Kebangsaan Malaysia Medical Centre (UKMMC) using face-to-face administered questionnaires. Results: In total 180 respondents were analysed. There were 177 (98.3%) males. Mean age was 59.8 ± 9.1 years. Of the respondents, 138 (76.7%) had poor knowledge about cancer screening. Former smokers comprised 119 (66.1%) of the participants, and 61 (33.9%) were current smokers. In total, 141 (78.3%) respondents indicated willingness to participate in a lung cancer screening programme. Out of this group, 68 (48.2%) respondents were unwilling to pay for the procedure. Only 18 (12.8%) were unwilling to undergo lung cancer treatment if detected early. Conclusions: Awareness about general cancer screening is low. Our study showed that when informed of their high-risk status, respondents were willing to participate in lung cancer screening. There should be more health programmes to promote and raise awareness about lung cancer.
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Affiliation(s)
- Wei Hao Kok
- Department of Medicine,Respiratory Unit, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Andrea Ban Yu-Lin
- Department of Medicine,Respiratory Unit, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Shamsul Azhar Shah
- Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Faisal Abdul Hamid
- Department of Medicine,Respiratory Unit, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Ruparel M, Quaife S, Baldwin D, Waller J, Janes S. Defining the information needs of lung cancer screening participants: a qualitative study. BMJ Open Respir Res 2019; 6:e000448. [PMID: 31803474 PMCID: PMC6890387 DOI: 10.1136/bmjresp-2019-000448] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 10/09/2019] [Accepted: 11/06/2019] [Indexed: 01/10/2023] Open
Abstract
Introduction Lung cancer screening (LCS) by low-dose CT has been shown to improve mortality, but individuals must consider the potential benefits and harms before making an informed decision about taking part. Shared decision-making is required for LCS in USA, though screening-eligible individuals' specific views of these harms, and their preferences for accessing this information, are not well described. Methods In this qualitative study, we aimed to explore knowledge and perceptions around lung cancer and LCS with a focus on harms. We carried out seven focus groups with screening-eligible individuals, which were divided into current versus former smokers and lower versus higher educational backgrounds; and 16 interviews with health professionals including general practitioners, respiratory physicians, lung cancer nurse specialists and public health consultants. Interviews and focus groups were audio-recorded and transcribed. Data were coded inductively and analysed using the framework method. Results Fatalistic views about lung cancer as an incurable disease dominated, particularly among current smokers, and participants were often unaware of curative treatment options. Despite this, beliefs that screening is sensible and worthwhile were expressed. Generally participants felt they had the 'right' to an informed decision, though some cautioned against information overload. The potential harms of LCS were poorly understood, particularly overdiagnosis and radiation exposure, but participants were unlikely to be deterred by them. Strong concerns about false-negative results were expressed, while false-positive results and indeterminate nodules were also reported as concerning. Conclusions These findings demonstrate the need for LCS information materials to highlight information on the benefits of early detection and options for curative treatment, while accurately presenting the possible harms. Information needs are likely to vary between individuals and we recommend simple information materials to be made available to all individuals considering participating in LCS, with signposting to more detailed information for those who require it.
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Affiliation(s)
- Mamta Ruparel
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Samantha Quaife
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - David Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jo Waller
- Research Department of Behavioural Science and Health, University College London, London, UK
- Cancer Prevention Group, King's College London, London, UK
| | - Samuel Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
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Association of invitation to lung cancer screening and tobacco use outcomes in a VA demonstration project. Prev Med Rep 2019; 16:101023. [PMID: 31788415 PMCID: PMC6879990 DOI: 10.1016/j.pmedr.2019.101023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 11/05/2019] [Accepted: 11/13/2019] [Indexed: 12/15/2022] Open
Abstract
A potential unintended consequence of lung cancer screening (LCS) is an adverse effect on smoking behaviors. This has been difficult to assess in previous randomized clinical trials. Our goal was to determine whether cessation and relapse behaviors differ between Veterans directly invited (DI) to participate in LCS compared to usual care (UC). We conducted a longitudinal survey of tobacco use outcomes among Veterans (Minneapolis VA) from 2014 to 2015, randomized (2:1) to DI versus UC and stratified by baseline smoking status (current/former). Within the DI group, we explored differences between those who did and did not choose to undergo LCS. A total of 979 patients (n = 660 DI, n = 319 UC) returned the survey at a median of 484 days. Among current smokers (n = 488), smoking abstinence rates and cessation attempts did not differ between DI and UC groups. More baseline smokers in DI were non-daily smokers at follow-up compared to those in UC (25.3% vs 15.6%, OR 1.97 95%CI 1.15–3.36). A significant proportion of former smokers at baseline relapsed, with 17% overall indicating past 30-day smoking. This did not differ between arms. Of those invited to LCS, smoking outcomes did not significantly differ between those who chose to be screened (161/660) versus not. This randomized program evaluation of smoking behaviors in the context of invitation to LCS observed no adverse or beneficial effects on tobacco cessation or relapse among participants invited to LCS, or among those who completed screening. As LCS programs scale and spread nationally, effective cessation programs will be essential.
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Hyland KA, Jacobs JM, Lennes IT, Pirl WF, Park ER. Are cancer survivors following the national comprehensive cancer network health behavior guidelines? An assessment of patients attending a cancer survivorship clinic. J Psychosoc Oncol 2019; 36:64-81. [PMID: 29303476 DOI: 10.1080/07347332.2017.1399193] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Engaging in positive health behaviors post-treatment is important for cancer survivors' health. However, little is known about whether survivors are practicing health promoting behaviors. We aimed to explore whether survivors are meeting the recent health behavior guidelines set forth by the National Comprehensive Cancer Network (NCCN) and to examine associations between health behaviors and distress. METHODS Sixty-six survivors completed a cross-sectional questionnaire assessing health behaviors prior to an initial appointment at a survivorship care clinic. Information about sociodemographic, clinical, and psychosocial variables and six health behavior recommendations, including physical activity, sunscreen use, tobacco use, alcohol consumption, weight management, and annual primary care provider visits, was collected. FINDINGS Only 7.6% of survivors met all six NCCN health behavior guidelines. One in ten (10.6%) survivors had smoked a cigarette in the previous 30 days, and half did not use sunscreen regularly (50%), had an unhealthy body mass index (53%), and did not engage in >10 MET-h/week of physical activity (50%). Approximately 1 in 6 (15.1%) survivors reported drinking beyond the recommended limit, and a similar proportion had not seen a PCP in the previous year (27.3%). Clinically significant levels of distress (>5; range 0-10) on the NCCN distress scale were reported by 64.6% of survivors. Participants with clinical levels of distress were less likely to adhere to health behavior guidelines than those who were not distressed (p = .002). CONCLUSIONS Overall, survivors engaged at a survivorship clinic did not meet the NCCN recommended health behavior guidelines. Implications for Psychosocial Providers or Policy: Survivors' health behaviors and distress should be assessed and intervened upon during survivorship care. Survivorship clinics may provide a unique forum in which to provide ongoing behavioral health counseling and psychosocial support for these patients.
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Affiliation(s)
- Kelly A Hyland
- a Department of Health Outcomes and Behavior , Moffitt Cancer Center , Tampa , Florida , USA.,b Department of Psychology , University of South Florida , Tampa , Florida , USA.,e Department of Psychiatry , Sylvester Comprehensive Cancer Center , Miami , Florida , USA
| | - Jamie M Jacobs
- c Massachusetts General Hospital Cancer Center , Boston , Massachusetts , USA.,d Mongan Institute for Health Policy, Massachusetts General Hospital , Boston , Massachusetts , USA
| | - Inga T Lennes
- c Massachusetts General Hospital Cancer Center , Boston , Massachusetts , USA
| | - William F Pirl
- c Massachusetts General Hospital Cancer Center , Boston , Massachusetts , USA.,d Mongan Institute for Health Policy, Massachusetts General Hospital , Boston , Massachusetts , USA.,f Sylvester Cancer Center , Miami , Florida , USA
| | - Elyse R Park
- c Massachusetts General Hospital Cancer Center , Boston , Massachusetts , USA.,d Mongan Institute for Health Policy, Massachusetts General Hospital , Boston , Massachusetts , USA.,e Department of Psychiatry , Sylvester Comprehensive Cancer Center , Miami , Florida , USA
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Perez GK, Gareen IF, Sicks J, Lathan C, Carr A, Kumar P, Ponzani C, Hyland K, Park ER. Racial Differences in Smoking-related Disease Risk Perceptions Among Adults Completing Lung Cancer Screening: Follow-up Results from the ACRIN/NLST Ancillary Study. J Racial Ethn Health Disparities 2019; 6:676-685. [PMID: 30737732 PMCID: PMC6660997 DOI: 10.1007/s40615-019-00566-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 10/27/2022]
Abstract
Previous work suggests that, compared to white adults, black adults have lower perceived risk for smoking-related diseases (SRDs), which may influence cessation behavior and health outcomes; however, racial differences in SRD risk perceptions among high-risk patients (i.e., a group that exhibits elevated risk for SRDs) following lung screening remain unknown. This paper thus examined differences in risk perceptions for lung cancer and other SRDs among black and white National Lung Screening Trial (NLST) participants. We administered a 10-item measure of perceived lifetime risk of lung cancer and other SRD (Smoking Risk Perceptions Scale; SRPS) to NLST participants at 1 year following lung screening to (1) establish the internal consistency of the SRPS for both black and white participants, (2) compare smoking-related disease risk perceptions between black and white participants, and (3) identify predictors of risk perceptions for black and white participants using multivariable linear regression models. We determined the SRPS items loaded onto two factors (personal and comparative risks; Cronbach's alpha = 0.93 and 0.95 for 1743 white and 194 black participants, respectively), thus demonstrating high internal consistency for both black and white adults. Compared to white participants, black adults demonstrated lower SRD risk perceptions (SRPS range = 10-50, mean difference = 2.55, SE = 0.50, p < 0.001), even after adjusting for smoking status and sociodemographics. Younger age, female gender, higher education, white race, and current smoking status were independently associated with high risk perceptions. Sociodemographic factors associated with lower risk perceptions resemble factors related to continued smoking. Findings suggest current and former black smokers are at risk of having lower risk perceptions for lung cancer and SRDs than white adults following lung cancer screening; these differences may explain observed racial differences in cessation outcomes. Although similar factors influence black and white adults' beliefs, risk perceptions may differentially impact smoking behavior among these groups. Behavior change models that guide tobacco treatment approaches, particularly for high-risk black smokers, should consider the influence of cultural factors on risk perceptions and cessation efforts.
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Affiliation(s)
- Giselle K Perez
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 100 Cambridge Street, 15th floor, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Ilana F Gareen
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA
| | - JoRean Sicks
- Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Christopher Lathan
- Harvard Medical School, Boston, MA, USA
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Alaina Carr
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 100 Cambridge Street, 15th floor, Boston, MA, 02114, USA
| | - Pallavi Kumar
- Abramsom Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Kelly Hyland
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 100 Cambridge Street, 15th floor, Boston, MA, 02114, USA
- University of South Florida and Moffitt Cancer Center, Tampa, FL, USA
| | - Elyse R Park
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 100 Cambridge Street, 15th floor, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
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Hall DL, Jimenez RB, Perez GK, Rabin J, Quain K, Yeh GY, Park ER, Peppercorn JM. Fear of Cancer Recurrence: A Model Examination of Physical Symptoms, Emotional Distress, and Health Behavior Change. J Oncol Pract 2019; 15:e787-e797. [PMID: 31298966 DOI: 10.1200/jop.18.00787] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Fear of cancer recurrence is highly prevalent among adult survivors of cancer. The role of fear of recurrence in the emotional distress of survivors of cancer, as well as health behaviors that may directly affect their health, remains unclear. To advance oncology practice, this study sought to examine the extent to which fear of recurrence stemming from physical symptoms accounts for emotional distress in a large sample of adult survivors of cancer and to extend the model to explain postdiagnosis self-reported health behavior change. METHODS In 2016, 258 survivors of cancer at an academic hospital completed a survey of psychosocial needs. Items assessed physical symptoms (checklist), fear of cancer recurrence (Assessment of Survivor Concerns), emotional distress (anxiety and depressed mood), and health behaviors (current alcohol use, physical activity, diet, and sunscreen use, as well as changes after cancer diagnosis) informed by National Comprehensive Cancer Network survivorship guidelines. Indirect effects regression models accounting for relevant covariates (age and treatment history) used 5,000-iteration bootstrapping. RESULTS Higher fear of cancer recurrence was associated with greater number of physical symptoms (P < .001), greater emotional distress (P < .05), lower moderate or vigorous physical activity (P < .05), higher sunscreen use (P < .05), and postdiagnosis increases in alcohol use (P < .01) and reductions in physical activity (P < .01). Fear of cancer recurrence models accounted for almost half of the variance in distress of survivors of cancer (R2 = 0.44, P < .001) and, to a lesser yet significant extent, changes in alcohol consumption (R2 = 0.09, P < .001) and physical activity (R2 = 0.06, P = .003). CONCLUSION Fear of cancer recurrence plays a central role in the emotional distress and key health behaviors of survivors of cancer. These findings support fear of cancer recurrence as a potential target for emotional health and health behavior change interventions.
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Affiliation(s)
- Daniel L Hall
- Harvard Medical School/Massachusetts General Hospital, Boston, MA.,Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA
| | - Rachel B Jimenez
- Harvard Medical School/Massachusetts General Hospital, Boston, MA
| | - Giselle K Perez
- Harvard Medical School/Massachusetts General Hospital, Boston, MA.,Mongan Health Policy Research Center, Massachusetts General Hospital, Boston, MA
| | - Julia Rabin
- Harvard Medical School/Massachusetts General Hospital, Boston, MA
| | - Katharine Quain
- Harvard Medical School/Massachusetts General Hospital, Boston, MA
| | - Gloria Y Yeh
- Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA
| | - Elyse R Park
- Harvard Medical School/Massachusetts General Hospital, Boston, MA.,Mongan Health Policy Research Center, Massachusetts General Hospital, Boston, MA
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Hall DL, Neil JM, Ostroff JS, Hawari S, O'Cleirigh C, Park ER. Perceived cancer-related benefits of quitting smoking and associations with quit intentions among recently diagnosed cancer patients. J Health Psychol 2019; 26:831-842. [PMID: 31035808 DOI: 10.1177/1359105319845131] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
One third of smokers diagnosed with cancer continue smoking, perhaps due to low perceived cancer-related benefits of cessation. To examine perceived cancer-related benefits of quitting among newly diagnosed cancer patients who smoke and associations with quit intentions, baseline measures from patients (N = 303) enrolled in a randomized controlled trial were analyzed using hierarchical regression models and bootstrapping. Higher perceived cancer-related benefits of quitting were associated with having a smoking-related cancer and less education. Perceived cancer-related benefits of quitting and quit intentions were positively correlated, particularly among patients with smoking-related cancers. For smokers with smoking-related cancers, perceived cancer-related benefits of quitting are correlated with quit intentions.
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Affiliation(s)
- Daniel L Hall
- Massachusetts General Hospital, USA.,Harvard Medical School, USA
| | - Jordan M Neil
- Massachusetts General Hospital, USA.,Harvard Medical School, USA
| | | | - Saif Hawari
- Massachusetts General Hospital, USA.,Harvard Medical School, USA
| | | | - Elyse R Park
- Massachusetts General Hospital, USA.,Harvard Medical School, USA
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36
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Young B, Vedhara K, Kendrick D, Littleford R, Robertson JFR, Sullivan FM, Schembri S, das Nair R. Determinants of motivation to quit in smokers screened for the early detection of lung cancer: a qualitative study. BMC Public Health 2018; 18:1276. [PMID: 30453929 PMCID: PMC6245764 DOI: 10.1186/s12889-018-6211-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 11/08/2018] [Indexed: 12/05/2022] Open
Abstract
Background The promotion of smoking cessation within lung cancer screening could lead to benefits for smoking-related disease and improve cost-effectiveness of screening. Little is known about how smokers respond to lung cancer screening and how this impacts smoking behaviour. We aimed to understand how lung cancer screening influences individual motivations about smoking, including in those who have stopped smoking since screening. Methods Thirty one long-term smokers aged 51–74 took part in semi-structured interviews about smoking. They had been screened with the EarlyCDT-Lung Test (13 positive result; 18 negative) as part of the Early Cancer Detection Test Lung Cancer Scotland Study. They were purposively sampled for interview based on their self-reported post-screening smoking behaviour. Eleven participants had stopped smoking since screening. Verbatim interview transcripts were analysed using thematic analysis. Results Two key overarching themes were interpretations of screening test results and emotional responses to those interpretations. Participants’ understanding of the risk implied by their test result was often inaccurate, for example a negative result interpreted as an ‘all-clear’ from lung cancer and a positive result as meaning lung cancer would definitely develop. Those interpretations led to emotional responses (fear, shock, worry, relief, indifference) influencing motivations about smoking. Other themes included a wake-up call causing changes in perceived risk of smoking-related disease, a feeling that now is the time to stop smoking and family influences. There was no clear pattern in smoking motivations in those who received positive or negative test results. Of those who had stopped smoking, some cited screening experiences as the sole motivation, some cited screening along with other coinciding factors, and others cited non-screening reasons. Cues to change were experienced at different stages of the screening process. Some participants indicated they underwent screening to try and stop smoking, while others expressed little or no desire to stop. Conclusions We observed complex and individualised motivations about smoking following lung cancer screening. To be most effective, smoking cessation support in this context should explore understanding of screening test results and may need to be highly tailored to individual emotional responses to screening. Electronic supplementary material The online version of this article (10.1186/s12889-018-6211-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ben Young
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Kavita Vedhara
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | | | - John F R Robertson
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK
| | | | | | - Roshan das Nair
- Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
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Low-dose computed tomography screening reduces lung cancer mortality. Adv Med Sci 2018; 63:230-236. [PMID: 29425790 DOI: 10.1016/j.advms.2017.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 12/12/2017] [Accepted: 12/17/2017] [Indexed: 12/17/2022]
Abstract
Lung cancer causes an estimated 1.6 million deaths each year, being the leading cause of cancer-related deaths in the world. Late diagnosis and, in some cases, the high aggressiveness of the tumour result in low overall five-year survival rates of 12% among men and 7% among women. The cure is most likely in early-stage disease. The poor outcomes of treatment in lung cancer resulting from the fact that most cases are diagnosed in the advanced stage of the disease justify the implementation of an optimal lung cancer prevention in the form of smoking cessation and screening programmes that would offer a chance to detect early stages of the disease, while fitting within specific economic constraints. The National Lung Screening Trial (NLST) - the largest and most expensive randomised, clinical trial in the USA demonstrated a 20% mortality rate reduction in patients who had undergone chest low-dose computed tomography (LDCT) screening, as compared to patients screened with a conventional chest X-ray. Results of the NLST enabled the implementation of lung cancer screening programme among highrisk patients in the USA and parts of China. In 2017, recommendations of the European Society of Thoracic Surgeons also strongly recommend an implementation of a screening programme in the EU. Further studies of improved lung cancer risk assessment scores and of effective molecular markers should intensify in order to reduce all potential harms to the high-risk group and to increase cost-effectiveness of the screening.
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Roth JA, Carter-Harris L, Brandzel S, Buist DSM, Wernli KJ. A qualitative study exploring patient motivations for screening for lung cancer. PLoS One 2018; 13:e0196758. [PMID: 29975709 PMCID: PMC6033377 DOI: 10.1371/journal.pone.0196758] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 04/19/2018] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Low-dose computed tomography (LDCT) of the chest for lung cancer screening of heavy smokers was given a 'B' rating by the U.S. Preventive Services Task Force (USPSTF) in 2013, and gained widespread insurance coverage in the U.S. in 2015. Lung cancer screening has since had low uptake. However, for those that do choose to screen, little is known about patient motivations for completing screening in real-world practice. OBJECTIVE To explore the motivations for screening-eligible patients to screen for lung cancer. METHODS Semi-structured qualitative interviews were conducted with 20 LDCT screen-completed men and women who were members of an integrated mixed-model healthcare system in Washington State. From June to September 2015, participants were recruited and individual interviews performed about motivations to screen for lung cancer. Audio-recorded interviews were transcribed and analyzed using inductive content analysis by three investigators. RESULTS Four primary themes emerged as motivations for completing LDCT lung cancer screening: 1) trust in the referring clinician; 2) early-detection benefit; 3) low or limited harm perception; and 4) friends or family with advanced cancer. CONCLUSION Participants in our study were primarily motivated to screen for lung cancer based on perceived benefit of early-detection, absence of safety concerns, and personal relationships. Our findings provide new insights about patient motivations to screen, and can potentially be used to improve lung cancer screening uptake and shared decision-making processes.
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Affiliation(s)
- Joshua A. Roth
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Comparative Health Outcomes, Policy, and Economics Institute, University of Washington, Seattle, Washington, United States of America
| | - Lisa Carter-Harris
- School of Nursing, Indiana University, Indianapolis, Indiana, United States of America
| | - Susan Brandzel
- Health Stories Project Insights, Seattle, Washington, United States of America
| | - Diana S. M. Buist
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, United States of America
| | - Karen J. Wernli
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, United States of America
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Minnix JA, Karam-Hage M, Blalock JA, Cinciripini PM. The importance of incorporating smoking cessation into lung cancer screening. Transl Lung Cancer Res 2018; 7:272-280. [PMID: 30050765 DOI: 10.21037/tlcr.2018.05.03] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lung cancer is the leading cause of cancer-related death in the United States (U.S.) and is the second most common non-skin cancer among men and women, accounting for about 30% of cancer-related deaths. There is clear and accumulating evidence that continued tobacco use has multiple adverse effects on cancer treatment outcomes, including greater probability of recurrence, second primary malignancies, reduced survival, greater symptom burden, and poorer quality of life (QOL). Recent findings suggest an avenue to significantly mitigate the impact of smoking on lung cancer mortality rates through the use of low-dose computed tomography (LDCT) lung cancer screening. Based on the reviewed evidence (type B), the U.S. Preventive Services Task Force (USPSTF) guidelines of 2015 recommend screening combined with smoking cessation interventions for high-risk heavy smokers and recent quitters. These practice changes offer opportunities to develop novel smoking cessation strategies tailored to highly specific settings that aim to amplify the survivorship gains expected from screening alone. However, there is a paucity of research and data that speaks to the feasibility and efficacy of providing smoking cessation treatment specifically within the context of the LDCT lung cancer screening environment. While some studies have attempted to characterize the parameters within which smoking cessation interventions should be implemented in this context, further research is needed to explore relevant factors such as the format, components, and timing of interventions, as well as the influence of risk perceptions and results of the screening itself on motivation and ability to quit smoking.
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Affiliation(s)
- Jennifer Anne Minnix
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maher Karam-Hage
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Janice A Blalock
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paul M Cinciripini
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Maynard OM, Gove H, Skinner AL, Munafò MR. Severity and susceptibility: measuring the perceived effectiveness and believability of tobacco health warnings. BMC Public Health 2018; 18:468. [PMID: 29636038 PMCID: PMC5894175 DOI: 10.1186/s12889-018-5385-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 03/27/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Pictorial tobacco health warning labels (HWLs) have been shown to be more effective than text-only HWLs in changing smoking attitudes and intentions. However, there is contradictory evidence regarding how the severity of the content of HWLs influences responses to them. METHODS We examined the perceived believability and effectiveness of HWLs in an online study using a convenience sample of non-smokers (N = 437) and smokers (N = 436). HWLs were in one of three presentation formats: (text-only, a moderately severe image or highly severe image) and focussed on three disease outcomes (lung cancer, blindness or tooth and gum disease). Participants rated the effectiveness and believability of each HWL and also rated their perceived susceptibility to each disease. RESULTS A 2 (smoking status) × 3 (presentation format) × 3 (disease outcome) ANOVA was run for both believability and effectiveness ratings. The most severe pictorial HWLs received the highest believability and effectiveness ratings and as expected, the text-only HWLs received the lowest. Lung cancer HWLs were rated most believable and effective, with the blindness HWLs receiving the lowest scores. A 2 (smoking status) × 3 (disease outcome) ANOVA was conducted on the ratings of perceived susceptibility to the three diseases. Smokers considered themselves to be more susceptible to all three diseases, and among smokers, perceived susceptibility to the diseases was positively correlated with effectiveness and believability ratings of the HWLs. CONCLUSION Our findings support previous evidence that pictorial HWLs are rated as more effective and believable than text-only warnings, and provide some support for the use of severe or 'grotesque' HWLs on tobacco products. Our data also suggest that HWLs should aim to increase perceived susceptibility to disease, as this was positively related to perceived message effectiveness and believability.
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Affiliation(s)
- Olivia M. Maynard
- MRC Integrative Epidemiology Unit, University of Bristol, School of Experimental Psychology, 12a Priory Road, Bristol, BS81TU UK
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol, BS8 1TU UK
| | - Harry Gove
- Department of Psychology, University of Bath, Bath, BA27AY UK
| | - Andrew L. Skinner
- MRC Integrative Epidemiology Unit, University of Bristol, School of Experimental Psychology, 12a Priory Road, Bristol, BS81TU UK
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol, BS8 1TU UK
| | - Marcus R. Munafò
- MRC Integrative Epidemiology Unit, University of Bristol, School of Experimental Psychology, 12a Priory Road, Bristol, BS81TU UK
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol, BS8 1TU UK
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Hall DL, Lennes IT, Carr A, Eusebio JR, Yeh GY, Park ER. Lung Cancer Screening Uncertainty among Patients Undergoing LDCT. Am J Health Behav 2018; 42:69-76. [PMID: 29320340 PMCID: PMC5777324 DOI: 10.5993/ajhb.42.1.7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Lung cancer is the leading cause of cancer death, yet lung screening remains underutilized. Lung cancer screening uncertainty (LCSU), including referral clarity and the perceived accuracy of screening, may hinder utilization and represent an unmet psychosocial need. This study sought to identify correlates of LCSU among lung screening patients. METHODS Current and former smokers (N = 169) completed questionnaires assessing LCSU, sociodemographic variables, objective and subjective numeracy, stress, and anxiety, as part of a cross-sectional study of lung screening patients at an academic hospital. RESULTS Patients (52% current smok- ers) reported high clarity about the reason for their lung screening referral. Less clarity was as- sociated with lower education, not receiving Medicare, and greater stress and anxiety. Patients perceived lung screening to be moderately accurate, and levels were inversely related to objective numeracy. Subjective numeracy was higher among former versus current smokers (OR = 2.5), yet was unrelated to LCSU variables. CONCLUSIONS Several sociodemographic, numeracy, and emotional factors were associated with greater LCSU. With multiple policy and clinical guidelines purporting the uptake of annual lung screening, it is important to identify patients with LCSU and tailor shared decision-making to clarify their uncertainties.
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Affiliation(s)
- Daniel L Hall
- Harvard Medical School/Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
| | - Inga T Lennes
- Massachusetts General Hospital Cancer Center, Boston, MAMassachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Alaina Carr
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | | | - Gloria Y Yeh
- Harvard Medical School/Beth Israel Deaconess Medical Center, Division of General Medicine and Primary Care, Boston, MA, USA
| | - Elyse R Park
- Harvard Medical School/Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
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Fu SS, Rothman AJ, Vock DM, Lindgren B, Almirall D, Begnaud A, Melzer A, Schertz K, Glaeser S, Hammett P, Joseph AM. Program for lung cancer screening and tobacco cessation: Study protocol of a sequential, multiple assignment, randomized trial. Contemp Clin Trials 2017; 60:86-95. [PMID: 28687349 PMCID: PMC5558455 DOI: 10.1016/j.cct.2017.07.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/20/2017] [Accepted: 07/03/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Steven S Fu
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, United States; Department of Medicine, University of Minnesota, Minneapolis, MN, United States.
| | - Alexander J Rothman
- Department of Psychology, University of Minnesota, Minneapolis, MN, United States
| | - David M Vock
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, United States
| | - Bruce Lindgren
- Biostatistics and Bioinformatics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States
| | - Daniel Almirall
- Survey Research Center, Institute for Social Research, University of Michigan, United States
| | - Abbie Begnaud
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Anne Melzer
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, United States; Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Kelsey Schertz
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Susan Glaeser
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Patrick Hammett
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, United States; Department of Medicine, University of Minnesota, Minneapolis, MN, United States; Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, United States
| | - Anne M Joseph
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
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Quaife SL, Marlow LAV, McEwen A, Janes SM, Wardle J. Attitudes towards lung cancer screening in socioeconomically deprived and heavy smoking communities: informing screening communication. Health Expect 2017; 20:563-573. [PMID: 27397651 PMCID: PMC5513004 DOI: 10.1111/hex.12481] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND While discussion continues over the future implementation of lung cancer screening, low participation from higher risk groups could limit the effectiveness of any national screening programme. OBJECTIVES To compare smokers' beliefs about lung cancer screening with those of former and never smokers within a low socioeconomic status (SES) sample, to explore the views of lower SES smokers and ex-smokers in-depth, and to provide insights into effective engagement strategies. DESIGN, SETTING AND PARTICIPANTS Using proactive, community-based recruitment methods, we surveyed 175 individuals from socioeconomically deprived communities with high smoking prevalence and subsequently interviewed 21 smokers and ex-smokers. Participants were approached in community settings or responded to a mail-out from their housing association. RESULTS Interviewees were supportive of screening in principle, but many were doubtful about its ability to deliver long-term survival benefit for their generation of "heavy smokers." Lung cancer was perceived as an uncontrollable disease, and the survey data showed that fatalism, worry and perceived risk of lung cancer were particularly high among smokers compared with non-smokers. Perceived blame and stigma around lung cancer as a self-inflicted smokers' disease were implicated by interviewees as important social deterrents of screening participation. The belief that lungs are not a treatable organ appeared to be a common lay explanation for poor survival and undermined the potential value of screening. CONCLUSIONS Attitudes towards screening among this high-risk group are complex. Invitation strategies need to be carefully devised to achieve equitable participation in screening.
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Affiliation(s)
- Samantha L. Quaife
- Health Behaviour Research CentreDepartment of Epidemiology and Public HealthUniversity College LondonLondonUK
| | - Laura A. V. Marlow
- Health Behaviour Research CentreDepartment of Epidemiology and Public HealthUniversity College LondonLondonUK
| | - Andy McEwen
- Health Behaviour Research CentreDepartment of Epidemiology and Public HealthUniversity College LondonLondonUK
| | - Samuel M. Janes
- Lungs for Living Research CentreUCL RespiratoryDivision of MedicineUniversity College LondonLondonUK
| | - Jane Wardle
- Health Behaviour Research CentreDepartment of Epidemiology and Public HealthUniversity College LondonLondonUK
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Macauda MM, Thrasher JF, Saul JE, Celestino P, Cummings KM, Strayer SM. A Good Idea May Not Be Good Enough: Stakeholder Buy In to QuitConnect, a National Smokers' Registry. Am J Health Promot 2017; 32:1187-1195. [PMID: 28569071 DOI: 10.1177/0890117117708841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To examine interest and concerns among those who fund and operate state-run smoking cessation helplines (quitlines) about the concept of creating a centralized smokers' registry that could be used to reengage smokers after they receive initial quitline support services. DESIGN We conducted 3, hour-long focus groups with stakeholders, covering the perceived benefits and barriers to creating a smokers' registry. SETTING The focus groups were conducted via telephone. PARTICIPANTS Three groups participated: quitline service providers (n = 14), quitline funders (n = 9), and national quitline partners (n = 8). METHOD Data collection: Focus groups were recorded, transcribed, and coded for major relevant themes. Analysis Strategies: We used a grounded theory approach. RESULTS Stakeholders were generally positive about the concept of a centralized smokers' registry (ie, QuitConnect), especially with its potential to link relapsed smokers to ongoing research studies designed to help smokers achieve abstinence from tobacco. However, stakeholders expressed concern about QuitConnect duplicating services already offered by state quitlines. CONCLUSION Despite a common goal, many state quitline stakeholders had strong reservations about the creation of a centralized smokers' registry unless they could see clear evidence that the registry added value and was not duplicative of their existing services.
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Affiliation(s)
- Mark M Macauda
- 1 Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - James F Thrasher
- 1 Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Jessie E Saul
- 2 North American Research and Analysis, Inc, Faribault, MN, USA
| | - Paula Celestino
- 3 Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - K Michael Cummings
- 4 Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Scott M Strayer
- 5 Department of Family and Preventive Medicine, School of Medicine, University of South Carolina, Columbia, SC, USA
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Howell LA, Brockman TA, Sinicrope PS, Patten CA, Decker PA, Busta A, Stoddard S, McNallan SR, Yang P. Receptivity and Preferences for Lifestyle Programs to Reduce Cancer Risk among Lung Cancer Family Members. ADVANCES IN CANCER PREVENTION 2016; 1. [PMID: 27917414 PMCID: PMC5132181 DOI: 10.4172/2472-0429.1000110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Lifestyle factors and genetic information has been found to contribute to the occurrence of lung cancer. This study assessed receptivity to participating in lifestyle programs to reduce cancer risk among unaffected lung cancer family members. We also explored demographic, medical, and psychosocial correlates of willingness to participate in lifestyle programs. Methods Family members who are part of a lung Cancer Family Registry were asked to fill out a survey assessing their receptivity to cancer risk reduction programs including preferences for an individual or family-based program. Results Of the 583 respondents, 85% were “Somewhat” or “Definitely” willing to participate in a lifestyle program. Among those receptive, about half (56%) preferred a family-based approach. Preferred programs included weight management (36%) and nutritional information (30%). Preferred delivery channels were Internet (45%) and mail-based (29%) programs. On multivariate analysis, those definitely/somewhat receptive reported greater exercise self-efficacy scores (p=0.025). Conclusion The majority of the sample was receptive to lifestyle programs that might decrease cancer risk. There was a large preference for family-based weight management and nutritional programs. Further research is indicated to determine how to best incorporate a family-based approach to lifestyle programs for cancer family members.
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Affiliation(s)
- Lisa A Howell
- Department of Psychology and Psychiatry, Mayo Clinic, Rochester, MN 55905, USA
| | - Tabetha A Brockman
- Behavioral Health Research Program, Mayo Clinic, Rochester, MN 55905, USA
| | - Pamela S Sinicrope
- Department of Psychology and Psychiatry, Mayo Clinic, Rochester, MN 55905, USA; Behavioral Health Research Program, Mayo Clinic, Rochester, MN 55905, USA
| | - Christi A Patten
- Department of Psychology and Psychiatry, Mayo Clinic, Rochester, MN 55905, USA; Behavioral Health Research Program, Mayo Clinic, Rochester, MN 55905, USA
| | - Paul A Decker
- Department of Medical Genetics, Mayo Clinic, Rochester, MN 55905, USA; Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Allan Busta
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Shawn Stoddard
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Sheila R McNallan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Ping Yang
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
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Case K, Crook B, Lazard A, Mackert M. Formative research to identify perceptions of e-cigarettes in college students: Implications for future health communication campaigns. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2016; 64:380-389. [PMID: 26979833 PMCID: PMC4929619 DOI: 10.1080/07448481.2016.1158180] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE This formative study examined perceptions of e-cigarettes in college students with the goal of informing future health communication campaigns. Differences between e-cigarette users and nonusers were also examined. PARTICIPANTS Thirty undergraduate students were recruited from a large southwestern public university (15 users, 15 nonusers). METHODS Structured interviews were conducted and transcripts were coded for themes. RESULTS Although users had more favorable attitudes toward e-cigarettes, both users and nonusers believed that e-cigarettes produce water vapor and reported that e-cigarettes were less harmful than conventional cigarettes. Potential health consequences and addiction concerns were the most common perceived threats for both users and nonusers. Both nonusers and users cited social stigma as a perceived disadvantage of e-cigarette use. CONCLUSIONS Ultimately, themes with particular relevance to future health communication campaigns included negative perceptions of e-cigarette users and social stigma, as well as harm perceptions and potential health consequences associated with e-cigarette use.
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Affiliation(s)
- Kathleen Case
- University of Texas School of Public Health Austin Regional Campus, Austin, Texas, USA
| | - Brittani Crook
- University of Texas School of Public Health Austin Regional Campus, Austin, Texas, USA
| | - Allison Lazard
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael Mackert
- Stan Richards School of Advertising and Public Relations, University of Texas at Austin, Austin, Texas, USA
- University of Texas at Austin Center for Health Communication, University of Texas at Austin, Austin, Texas, USA
- School of Public Health, The University of Texas Health Science Center, Austin, Texas, USA
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Smoking cessation interventions within the context of Low-Dose Computed Tomography lung cancer screening: A systematic review. Lung Cancer 2016; 98:91-98. [PMID: 27393513 DOI: 10.1016/j.lungcan.2016.05.028] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/19/2016] [Accepted: 05/29/2016] [Indexed: 12/17/2022]
Abstract
The integration of smoking cessation interventions (SCIs) within the context of lung cancer screening programs is strongly recommended by screening guidelines, and is a requirement for Medicare coverage of screening in the US. In Europe, there are no lung cancer screening guidelines, however, research trials are ongoing, and prominent professional societies have begun to recommend lung cancer screening. Little is known about the types and efficacy of SCIs among patients receiving low-dose computed tomography (LDCT) screening. This review addresses this gap. Based on a systematic search, we identified six empirical studies published prior to July 1, 2015, that met inclusion criteria for our review: English language, SCI for LDCT patients, and reported smoking-related outcomes. Three randomized studies and three single-arm studies were identified. Two randomized controlled trials (RCTs) evaluated self-help SCIs, whereas one pilot RCT evaluated the timing (before or after the LDCT scan) of a combined (counseling and pharmacotherapy) SCI. Among the single-arm trials, two observational studies evaluated the efficacy of combined SCI, and one retrospectively assessed the efficacy of clinician-delivered smoking assessment, advice, and assistance. Given the limited research to date, and particularly the lack of studies reporting results from RCTs, assumptions that SCIs would be effective among this population should be made with caution. Findings from this review suggest that participation in a lung screening trial promotes smoking cessation and may represent a teachable moment to quit smoking. Findings also suggest that providers can take advantage of this potentially teachable moment, and that SCIs have been successfully implemented in screening settings. Continued systematic and methodologically sound research in this area will help improve the knowledge base and implementation of interventions for this population of smokers at risk for chronic disease.
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Kaufman AR, Koblitz AR, Persoskie A, Ferrer RA, Klein WMP, Dwyer LA, Park ER. Factor Structure and Stability of Smoking-Related Health Beliefs in the National Lung Screening Trial. Nicotine Tob Res 2016; 18:321-9. [PMID: 25964503 PMCID: PMC4757932 DOI: 10.1093/ntr/ntv091] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 04/19/2015] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Absolute and comparative risk perceptions, worry, perceived severity, perceived benefits, and self-efficacy are important theoretical determinants of tobacco use, but no measures have been validated to ensure the discriminant validity as well as test-retest reliability of these measures in the tobacco context. The purpose of the current study is to examine the reliability and factor structure of a measure assessing smoking-related health cognitions and emotions in a national sample of current and former heavy smokers in the National Lung Screening Trial. METHODS A sub-study of the National Lung Screening Trial assessed current and former smokers' (age 55-74; N = 4379) self-reported health cognitions and emotions at trial enrollment and at 12-month follow-up. Items were derived from the Health Belief Model and Self-Regulation Model. RESULTS An exploratory factor analysis of baseline responses revealed a five-factor structure for former smokers (risk perceptions, worry, perceived severity, perceived benefits, and self-efficacy) and a six-factor structure for current smokers, such that absolute risk and comparative risk perceptions emerged as separate factors. A confirmatory factor analysis of 12-month follow-up responses revealed a good fit for the five latent constructs for former smokers and six latent constructs for current smokers. Longitudinal stability of these constructs was also demonstrated. CONCLUSIONS This is the first study to examine tobacco-related health cognition and emotional constructs over time in current and former heavy smokers undergoing lung screening. This study found that the theoretical constructs were stable across time and that the factor structure differed based on smoking status (current vs. former).
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Affiliation(s)
- Annette R Kaufman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD;
| | - Amber R Koblitz
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Alexander Persoskie
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Rebecca A Ferrer
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - William M P Klein
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Laura A Dwyer
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Elyse R Park
- Massachusetts General Hospital Mongan Institute for Health Policy and Cancer Center, Boston, MA
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Marshall HM, Courtney DA, Passmore LH, McCaul EM, Yang IA, Bowman RV, Fong KM. Brief Tailored Smoking Cessation Counseling in a Lung Cancer Screening Population is Feasible: A Pilot Randomized Controlled Trial. Nicotine Tob Res 2016; 18:1665-9. [PMID: 26834052 DOI: 10.1093/ntr/ntw010] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 01/07/2016] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Maximizing smoking abstinence in lung cancer screening participants is important to reduce individual risk of disease and improve screening cost-effectiveness; however, the optimal strategy remains undefined. We hypothesized that a single session of tailored face-to-face counseling on the day of screening CT scan, coupled with audio and printed cessation information would be feasible to deliver in a CT screening trial. METHODS We randomized volunteer smokers in the Queensland Lung Cancer Screening Study to intervention (counseling session, audio quit materials, printed quit materials, Quitline contact details) or control group (printed quit materials, Quitline contact details). Participants self-reported point prevalence quit rates at 1 year. RESULTS Fifty-five smokers were enrolled; 28 randomized to intervention and 27 controls. Median cigarette consumption was 25/day; 54/55 smoked at least 15 cigarettes per day. Median smoking duration was 46 years. Median Fagerström dependence score was 6. In total 58% did not report any quit attempt in the prior 12 months. Mean duration of counseling was 26.5 minutes. After 1 year, four participants (14.3%) in the intervention group and five participants (18.5%) in the control group had quit (P = .74). Combined annual point prevalence quit rate was 16.4%. CONCLUSIONS Although feasible to deliver a single session of tailored counseling on the day of screening this intervention had no discernible impact on cessation over and above printed materials and Quitline access. As participants exhibited hardcore smoking characteristics, more intensive strategies, in larger cohorts, should be explored. IMPLICATIONS The optimal smoking cessation strategy within a lung cancer screening program is not known. This study demonstrates that a single session of counseling can be feasibly delivered on the day of screening but may not have been intensive enough for long-term, hard-core smokers.
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Affiliation(s)
- Henry M Marshall
- University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, Australia
| | - Deborah A Courtney
- University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, Australia
| | - Linda H Passmore
- University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, Australia
| | - Elizabeth M McCaul
- University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, Australia
| | - Ian A Yang
- University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, Australia
| | - Rayleen V Bowman
- University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, Australia
| | - Kwun M Fong
- University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, Australia
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50
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Warren GW, Ostroff JS, Goffin JR. Lung Cancer Screening, Cancer Treatment, and Addressing the Continuum of Health Risks Caused by Tobacco. Am Soc Clin Oncol Educ Book 2016; 35:223-9. [PMID: 27249702 DOI: 10.1200/edbk_158704] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Tobacco use is the largest preventable risk factor for the development of several cancers, and continued tobacco use by patients with cancer and survivors of cancer causes adverse outcomes. Worldwide tobacco control efforts have reduced tobacco use and improved health outcomes in many countries, but several countries continue to suffer from increased tobacco use and associated adverse health effects. Continued tobacco use by patients undergoing cancer screening or treatment results in continued risk for cancer-related and noncancer-related health conditions. Although integrating tobacco assessment and cessation support into lung cancer screening and cancer care is well justified and feasible, most patients with cancer unfortunately do not receive evidence-based tobacco cessation support. Combining evidence-based methods of treating tobacco addiction, such as behavioral counseling and pharmacotherapy, with practical clinical considerations in the setting of lung cancer screening and cancer treatment should result in substantial improvements in access to evidence-based care and resultant improvements in health risks and cancer treatment outcomes.
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Affiliation(s)
- Graham W Warren
- From the Departments of Radiation Oncology and Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Jamie S Ostroff
- From the Departments of Radiation Oncology and Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - John R Goffin
- From the Departments of Radiation Oncology and Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Oncology, McMaster University, Hamilton, Ontario, Canada
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