While the National Lung Screening Trial observed a 20% reduction in lung cancer mortality associated with annual chest CT screening among smokers, many questions remain about the real-world implications of implementing CT screening in clinical practice. One critical concern is that the message that early detection of lung cancer through CT screening can saves lives will be perceived as an alternative to smoking cessation and may inadvertently lead to lower motivation to quit. We propose to conduct a formative qualitative research project that is nested within the VHA's lung screening clinical demonstration project. This demonstration project is examining the feasibility of implementing CT screening within a small set of primary care teams in 8 states across the U.S. We propose to approach subjects shortly after being offered screening by their primary care provider to participate in telephone interviews about their perceptions and attitudes towards smoking cessation in the context of CT screening. Subjects who opt for screening will also be re-contacted after they receive the result of their screening test to further explore any shift in perceptions and attitudes about smoking cessation. We anticipate conducting approximately 40 interviews in order to include a diverse mix of subjects from across the 8 geographic areas involved in the demonstration project, and ensure representation of minority subjects and subjects from rural and low-income areas. Transcripts from the interviews will be assessed from an Interpretive Phenomenological Analysis perspective. This qualitative research approach focuses on examining the experience of the patient as they undergo CT screening and how the process of being offered screening and receiving the results of the CT screening test influences attitudes towards smoking cessation. The project will engage national leaders in VHA and in the community working on implementing lung cancer screening. Our long-term objective is to incorporate brief intervention messages into decision support materials for providers to use in primary care that integrate what it is like for patients to go through the experience of screening. As screening begins to be discussed in the clinic, we are realizing that we have very limited guidance about how best to discuss early detection of lung cancer, and integrate CT screening into the context of smoking cessation. This project is an initial step towards filling this critical gap.
This project will interview smokers shortly after being approached for lung cancer screening to explore how offering testing influences patient attitudes and preferences about smoking cessation. The findings will be used to develop educational and decision support materials that help ensure that offering screening does not inadvertently encourage patients to smoke.
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