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A5981 - Patient and Clinician Perspectives on Smoking Cessation in Three Lung Cancer Screening Programs
Author Block: S. Golden1, S. Ono1, R. S. Wiener2, A. C. Melzer3, J. Davis4, C. G. Slatore1; 1VA Portland Health Care System, Portland, OR, United States, 2Boston University School of Medicine, Boston, MA, United States, 3Pulmonary and Critical Care, Minneapolis VA Healthcare System, Minneapolis, MN, United States, 4Duke University Medical Center, Durham, NC, United States.
Rationale: Lung cancer screening (LCS) may be a “teachable moment” to counsel patients about the benefits of smoking abstinence, but systematic reviews of LCS trials suggest screening itself is not associated with smoking behavior changes. Methods: Qualitative evaluation of the experiences of 25 former or current smokers who underwent LCS decision-making discussions and 19 clinicians (either primary care clinicians or LCS coordinators) from three medical centers in the U.S. with established LCS programs. We focused on how they discussed smoking and screening, guided by the 5A framework of Ask, Advise, Assess, Assist, and Arrange. We used conventional content analysis. Results: Clinicians reported always advising abstinence during the LCS decision-making discussion but did not want to pressure patients or make them feel ashamed about smoking. They offered to assist and arrange resources for patients who desired to quit, and ensured those that were not ready were aware there were future opportunities for cessation resources. This largely mirrored patient experience. Participants felt they were asked about smoking, “gently” advised to quit, but only sometimes assessed for their readiness. If the patient was not ready to quit, they felt confident they could obtain resources if/when ready. Almost all clinicians reported they did not believe screening itself positively or negatively influenced patients’ motivation for abstinence. Many clinicians thought the LCS discussion, as it related to the patient’s risk of lung cancer, could be a teachable moment to positively influence the desire to quit. However, patients themselves reported other motivations for quitting, such as family encouragement, financial cost of smoking, and impact on their overall health and quality of life. Only four patients indicated that screening increased their desire for abstinence. All current smokers reported that receiving a screening CT was not an appropriate substitute for cessation, and in fact, acted with derision when queried. A representative quote when asked about this was, “I think that’s pretty stupid.” No former smokers indicated they would resume if their LCS scan was negative. Conclusions: Clinicians reported using the 5A framework. Some clinicians felt discussion of lung cancer risk could positively influence smoking behaviors. However, LCS itself and lung cancer risk did not seem to influence patient smoking behaviors differently than when discussed during other visits. These findings suggest that the LCS shared decision making visit may not be a significant moment for altering smoking behaviors and that patients do not view screening as a “license” to smoke.