Assessing the integration of tobacco cessation treatment into lung cancer screening

评估戒烟治疗与肺癌筛查的整合

基本信息

批准号：
10117200
负责人：
JENNIFER S HAAS
金额：
$ 74.46万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-04-16 至 2023-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10117200
关键词：
Abstinence Address Adherence Adopted Adoption Advisory Committees Age Biochemical Caring Cessation of life Characteristics Chronic Disease Common Data Element Communities Counseling Coupled Databases Development Disease Management Dose Enrollment Evaluation Fibrinogen Guidelines Health system Healthcare Systems Hour Individual Informal Social Control Integrated Delivery of Health Care Integrated Health Care Systems Intervention Language Link Lung Maintenance Malignant Neoplasms Malignant neoplasm of lung Medical Medicare Methods Modeling Morbidity - disease rate Motivation Nicotine Dependence Outcome Participant Patient Self-Report Patients Pharmacology Pharmacotherapy Population Prevalence Preventive service Process Measure Program Sustainability Provider Psychosocial Assessment and Care Radiology Specialty Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Readiness Reporting Resources Scanning Schedule Screening Result Series Services Site Smoker Smoking Smoking Cessation Intervention Smoking History Specialist System Technology Telephone Test Result Testing Time Tobacco Tobacco Use Cessation Training United States Videoconferencing Work base care coordination compare effectiveness cost cost effectiveness design effective intervention effective therapy effectiveness evaluation effectiveness implementation design effectiveness implementation study evidence base experience follow-up group intervention health belief health care delivery health care settings health information technology high risk low dose computed tomography lung cancer screening meetings mortality multidisciplinary nicotine replacement novel optimal treatments outreach patient engagement patient outreach patient population patient portal performance tests personalized intervention practice setting primary outcome programs randomized trial risk perception routine screening screening smoking cessation social social culture sociodemographic factors sociodemographics telehealth tobacco abstinence tobacco cessation intervention tool treatment program treatment services treatment strategy trial design

项目摘要

Abstract Lung cancer accounts for 27% of U.S. cancer deaths. The National Lung Screening Trial demonstrated that lung cancer screening (LCS) with low-dose computed tomography (LDCT) reduces lung cancer mortality. Guidelines recommend offering annual LCS accompanied by smoking cessation treatment to high-risk, older individuals. Payers cover LCS for high-risk individuals, and Medicare requires LCS sites to offer smoking cessation to current smokers. Health care systems adopting LCS have a critical new opportunity to deliver tobacco cessation treatment to smokers at a teachable moment. However, an optimal treatment strategy for these long-term, highly dependent smokers undergoing LCS has not yet been determined, and there are challenges to integrating tobacco treatment services into high-volume radiology practices. We propose a hybrid effectiveness-implementation design to examine the development, integration, and implementation of a novel, personalized, English and Spanish language, evidence-based smoking cessation intervention into LCS sites in a large, diverse, integrated health care delivery system, comprised of two networks. To maximize the reach of tobacco treatment, smokers will be offered personalized assistance and outreach at up to 3 time points (LCS test order, scan, and results). We will utilize novel health information technology (IT) platforms to promote patient outreach and access, using technologies like patient portals, informational videos (Vidscrip), and video- conferencing. Guided by the Health Belief and Self Regulation models with a chronic disease management perspective, the multi-component LCS-tailored intervention targets the older, long-term, heavy smokers who will undergo LCS. It provides counseling support and pharmacotherapy (nicotine replacement therapy [NRT]); is personalized to smokers' risk perceptions, readiness to quit, and LCS results; and systematic screening and referral to community-based resources to address social barriers to quitting. A centralized tobacco treatment specialist will deliver the intervention in a series of proactive motivational telephone- or videoconferencing- based sessions to sustain patient engagement. A randomized trial with a factorial design will test 3 intervention components that vary by (1) counseling duration, (2) NRT dose, and (3) systematic screening and referral for social barriers to quitting among 960 current smokers undergoing LCS at 6 screening sites. The primary outcome is biochemically-validated 7-day point-prevalence tobacco abstinence rates at 6 months. Exploratory analyses will identify patient- and LCS-level factors that moderate the relationship between intervention group and smoking outcomes, including socio-demographic characteristics, medical and smoking characteristics, and LCS-related factors (i.e., LCS result, time point of study entry). Guided by the RE-AIM framework, we will conduct a rigorous mixed methods evaluation of the intervention's reach, adoption, implementation (including cost-effectiveness from provider, payer and patient perspectives), and maintenance. Our program could provide health systems nationally with a sustainable model to integrate tobacco treatment into LCS screening.

抽象的肺癌占美国癌症死亡人数的 27%。全国肺部筛查试验表明低剂量计算机断层扫描 (LDCT) 肺癌筛查 (LCS) 可降低肺癌死亡率。指南建议向高危老年人提供年度 LCS 并伴随戒烟治疗个人。付款人为高危人群承保 LCS，Medicare 要求 LCS 站点提供吸烟服务当前吸烟者戒烟。采用 LCS 的医疗保健系统有一个重要的新机会来提供服务在教育时刻对吸烟者进行戒烟治疗。然而，最佳治疗策略这些长期、高度依赖的吸烟者接受 LCS 的情况尚未确定，并且有将烟草治疗服务纳入大量放射学实践的挑战。我们提出了一种混合动力有效性实施设计，用于检查新颖的、在 LCS 站点中进行个性化、英语和西班牙语、基于证据的戒烟干预一个庞大、多样化、综合的医疗保健提供系统，由两个网络组成。为了最大限度地扩大影响范围烟草治疗，吸烟者将在最多 3 个时间点获得个性化帮助和外展服务（LCS 测试顺序、扫描和结果）。我们将利用新型卫生信息技术（IT）平台来促进患者外展和访问，使用患者门户、信息视频 (Vidscrip) 和视频等技术会议。以健康信念和自我调节模型为指导，进行慢性病管理从长远来看，多成分 LCS 定制干预措施针对的是老年、长期、重度吸烟者将接受LCS。它提供咨询支持和药物治疗（尼古丁替代疗法[NRT]）；根据吸烟者的风险认知、戒烟意愿和 LCS 结果进行个性化；以及系统的筛选和转介社区资源来解决戒烟的社会障碍。集中烟草处理专家将通过一系列主动的激励性电话或视频会议进行干预基础会议以维持患者参与。采用析因设计的随机试验将测试 3 种干预措施组成部分因 (1) 咨询持续时间、(2) NRT 剂量和 (3) 系统筛查和转诊而异在 6 个筛查点接受 LCS 的 960 名当前吸烟者面临戒烟的社会障碍。初级结果是经过生物化学验证的 6 个月时 7 天点流行率的戒烟率。探索性分析将确定调节干预组之间关系的患者和 LCS 水平因素和吸烟结果，包括社会人口特征、医疗和吸烟特征，以及 LCS 相关因素（即 LCS 结果、进入研究的时间点）。在RE-AIM框架的指导下，我们将进行严格的混合方法评估干预措施的范围、采用、实施情况（包括成本效益从提供者、付款者和患者的角度来看），和维护。我们的该计划可以为全国卫生系统提供可持续的模式，将烟草治疗纳入 LCS筛选。