Lung cancer is the leading cause of cancer death in the U.S. The National Lung Screening Trial (NLST) documented that low-dose computed tomography (CT) lung cancer screening among individuals at high risk significantly reduced lung cancer mortality, although it was also associated with a high rate of false positives leading to over-diagnosis and increased anxiety. The American Cancer Society currently recommends CT screening for those who meet the NLST's original eligibility criteria and the U.S. Preventive Task Force will provide a scientific report on the subject in 2013. Current recommendations encourage physicians and patients to consider the benefits, risks, and limitations of CT screening to make a shared decision. As cigarette smoking is the leading risk factor for lung cancer, CT screening discussions also present a """"""""teachable moment"""""""" to promote smoking cessation and relapse prevention. The ultimate goal of the proposed research is to develop messages that will facilitate physician-patient discussions of lung cancer risk, CT screening, and smoking cessation/relapse prevention.
Our specific aims are as follows:
Aim 1. Examine patients'understanding of and concerns about lung cancer risk, CT screening, smoking cessation/ relapse prevention and the barriers/facilitators of each. We will conduct semi-structured interviews with multiethnic (black, Latino and White) bilingual (English or Spanish-speaking) current (n=15) and former (n=15) smokers who match NLST criteria and with patients (n=10) who have already undergone CT screening. Participants will be recruited from patients at the University of California, San Francisco.
Aim 2. Assess physicians'perspectives on, and barriers/facilitators of providing lung cancer risk, CT screening and smoking cessation information to patients. We will conduct semi-structured interviews with 16 primary care physicians identified from the San Francisco Bay Area Collaborative Research Network.
Aim 3. Assess current methods and practices of discussing lung cancer risk and CT screening results. We will conduct direct observation of 10 patients and their pulmonologists at the point of undergoing CT screening at UCSF, followed by semi-structured interviews. We will triangulate these data points to determine optimal communication strategies for physicians and their patients. We expect our research to produce a set of specific recommendations that will help physicians to communicate with their patients about lung cancer risk and CT screening, and promote informed decision-making among patients at high risk. These recommendations will also help physicians to encourage smoking cessation and relapse prevention among their patients.

Public Health Relevance

Low-dose computed tomography (CT) lung cancer screening among individuals at high risk, (e.g., current and former smokers) significantly reduces lung cancer mortality, although it has also been associated with a high rate of false positives resulting in over-diagnosis and increased anxiety. Lung cancer screening discussion can be used as a teachable moment to promote smoking cessation efforts among current smokers and to prevent smoking relapse among former smokers. The proposed study aims to develop communication strategies that will facilitate physician-patient discussion of CT screening and promote informed decision-making while encouraging smoking cessation and relapse prevention.

National Institute of Health (NIH)
National Center for Chronic Disease Prev and Health Promo (NCCDPHP)
Health Promotion and Disease Prevention Research Centers (U48)
Project #
Application #
Study Section
Special Emphasis Panel (ZDP1-EEO (7C))
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of California Berkeley
Public Health & Prev Medicine
Schools of Public Health
United States
Zip Code
Moskowitz, Joel M; McDonnell, Diana D; Kazinets, Gene et al. (2016) Online smoking cessation program for Korean Americans: Randomized trial to test effects of incentives for program completion and interim surveys. Prev Med 86:70-6
Friedman, Daniela B; Becofsky, Katie; Anderson, Lynda A et al. (2015) Public perceptions about risk and protective factors for cognitive health and impairment: a review of the literature. Int Psychogeriatr 27:1263-75
Gamba, Ryan J; Schuchter, Joseph; Rutt, Candace et al. (2015) Measuring the food environment and its effects on obesity in the United States: a systematic review of methods and results. J Community Health 40:464-75
Ivey, Susan L; Kealey, Melissa; Kurtovich, Elaine et al. (2015) Neighborhood characteristics and depressive symptoms in an older population. Aging Ment Health 19:713-22
Smith-Bindman, Rebecca; Moghadassi, Michelle; Wilson, Nicole et al. (2015) Radiation Doses in Consecutive CT Examinations from Five University of California Medical Centers. Radiology 277:134-41
Satariano, William A; Scharlach, Andrew E; Lindeman, David (2014) Aging, place, and technology: toward improving access and wellness in older populations. J Aging Health 26:1373-89
Hunter, Rebecca H; Anderson, Lynda A; Belza, Basia et al. (2013) Environments for healthy aging: linking prevention research and public health practice. Prev Chronic Dis 10:E55
Ivey, Susan L; Laditka, Sarah B; Price, Anna E et al. (2013) Experiences and concerns of family caregivers providing support to people with dementia: a cross-cultural perspective. Dementia (London) 12:806-20
Friedman, Daniela B; Rose, India D; Anderson, Lynda A et al. (2013) Beliefs and communication practices regarding cognitive functioning among consumers and primary care providers in the United States, 2009. Prev Chronic Dis 10:E58; quiz 8-13
Mullen, Sean P; McAuley, Edward; Satariano, William A et al. (2012) Physical activity and functional limitations in older adults: the influence of self-efficacy and functional performance. J Gerontol B Psychol Sci Soc Sci 67:354-61

Showing the most recent 10 out of 13 publications