Inpatient Smokers and LDCT Screening RCT
| Status: | Recruiting |
|---|---|
| Conditions: | Lung Cancer, Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 55 - 80 |
| Updated: | 8/11/2018 |
| Start Date: | November 7, 2017 |
| End Date: | December 2019 |
| Contact: | Hasmeena Kathuria, MD |
| Email: | hasmeena@bu.edu |
| Phone: | 617 638-4860 |
Capitalizing on Hospitalization to Engage Low SES Smokers in LDCT Screening: A Randomized Controlled Trial
Current smokers who undergo annual low dose CT (LDCT) lung cancer screening and successfully
quit smoking derive the greatest reduction in lung cancer mortality. Unfortunately, those at
highest risk of lung cancer death- those with low socioeconomic status, blacks, and current
smokers- are the same individuals that typically have reduced access to preventive healthcare
such as smoking cessation services and screening tests. Furthermore, patients from
underserved communities often have lower health literacy, less awareness of lung cancer
screening, and a poor understanding of the trade-offs of LDCT screening. In 2015 the Center
for Medicare and Medicaid Services began requiring (1) a shared decision-making (SDM)
discussion including use of a patient decision aid and (2) smoking cessation counseling in
order to receive reimbursement for LDCT screening. There is little guidance, however, to help
healthcare systems implement this requirement. Furthermore, primary care physicians (PCPs)
report time constraints, competing demands, and knowledge deficiencies as barriers to
optimizing utilization of LDCT screening.
quit smoking derive the greatest reduction in lung cancer mortality. Unfortunately, those at
highest risk of lung cancer death- those with low socioeconomic status, blacks, and current
smokers- are the same individuals that typically have reduced access to preventive healthcare
such as smoking cessation services and screening tests. Furthermore, patients from
underserved communities often have lower health literacy, less awareness of lung cancer
screening, and a poor understanding of the trade-offs of LDCT screening. In 2015 the Center
for Medicare and Medicaid Services began requiring (1) a shared decision-making (SDM)
discussion including use of a patient decision aid and (2) smoking cessation counseling in
order to receive reimbursement for LDCT screening. There is little guidance, however, to help
healthcare systems implement this requirement. Furthermore, primary care physicians (PCPs)
report time constraints, competing demands, and knowledge deficiencies as barriers to
optimizing utilization of LDCT screening.
The goal of this study is to create and evaluate an intervention that capitalizes on
hospitalization at an urban safety net hospital as an opportunity to connect high risk
smokers to lung cancer screening and smoking cessation services. Building on the
well-established inpatient tobacco dependence consult service at Boston Medical Center, the
investigators will study the effect of adding a nurse-driven LDCT screening SDM intervention
to inpatient smoking cessation counseling among screen-eligible hospitalized smokers.
Hospitalization may be an ideal time-point for this intervention as it offers 1) a "teachable
moment" for patients, when they may be particularly receptive to interventions to reduce
smoking-related disease, and 2) an opportunity to offload busy PCPs of the obligation to
conduct SDM for LDCT screening.
In Aim 1, screen-eligible patients who are smokers will be randomized into one of the study
arms (n=284, 142 per arm) to receive either inpatient 1) SDM (SDM by a thoracic oncology
nurse using a decision aid) or 2) usual care and a LDCT informational brochure during
inpatient smoking cessation consultation visits. In both arms the thoracic oncology nurse
will counsel patients on smoking cessation. The investigators hypothesize that for
screen-eligible smokers, inpatient SDM will increase (1) LDCT screening rates, (2) patient
knowledge of LDCT screening, and (3) 1 month smoking quit rates compared to usual care.
In Aim 2, the potential for future implementation of the intervention will be evaluated by
incorporating stakeholder impressions of the intervention through qualitative interviews. By
study end, an inpatient intervention will be created to promote both LDCT screening and
smoking cessation among low income and minority smokers. This hybrid study will allow te
investigators to establish not only the effectiveness of the intervention, but also help
inform future implementation.
hospitalization at an urban safety net hospital as an opportunity to connect high risk
smokers to lung cancer screening and smoking cessation services. Building on the
well-established inpatient tobacco dependence consult service at Boston Medical Center, the
investigators will study the effect of adding a nurse-driven LDCT screening SDM intervention
to inpatient smoking cessation counseling among screen-eligible hospitalized smokers.
Hospitalization may be an ideal time-point for this intervention as it offers 1) a "teachable
moment" for patients, when they may be particularly receptive to interventions to reduce
smoking-related disease, and 2) an opportunity to offload busy PCPs of the obligation to
conduct SDM for LDCT screening.
In Aim 1, screen-eligible patients who are smokers will be randomized into one of the study
arms (n=284, 142 per arm) to receive either inpatient 1) SDM (SDM by a thoracic oncology
nurse using a decision aid) or 2) usual care and a LDCT informational brochure during
inpatient smoking cessation consultation visits. In both arms the thoracic oncology nurse
will counsel patients on smoking cessation. The investigators hypothesize that for
screen-eligible smokers, inpatient SDM will increase (1) LDCT screening rates, (2) patient
knowledge of LDCT screening, and (3) 1 month smoking quit rates compared to usual care.
In Aim 2, the potential for future implementation of the intervention will be evaluated by
incorporating stakeholder impressions of the intervention through qualitative interviews. By
study end, an inpatient intervention will be created to promote both LDCT screening and
smoking cessation among low income and minority smokers. This hybrid study will allow te
investigators to establish not only the effectiveness of the intervention, but also help
inform future implementation.
Inclusion Criteria:
- hospitalized smokers at BMC meeting LDCT screening eligible criteria
- males and females 55-80 years of age
- ≥30-pack years smoking
- current smoker
- able to speak, read, and understand English
- able and willing to participate and provide informed consent
Exclusion Criteria:
- severe co-morbidities expected to limit life expectancy or ability to tolerate
surgical resection of a lung cancer, including patients requiring home oxygen therapy
(an indicator of severe lung or heart disease), and patients with active cancer
- patients who have already had LDCT screening in the past year
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