Inpatient Smokers and LDCT Screening RCT
Condition: Lung Cancer; Shared Decision Making
MeSH terms: Lung Neoplasms
Study type: Interventional

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): tobacco dependence/smoking cessation counseling; SDM; Decision Aid; LDCT brochure
Intervention type(s): Behavioral; Behavioral; Other; Other
Intervention description(s): Standard of care tobacco dependence/smoking cessation counseling offered to all smokers at Boston Medical Center.; SDM is three-fold to: 1) conduct a tailored discussion on tradeoffs of LDCT screening, consistent with CMS requirements for SDM using a decision aid; 2) directly connect interested patients to LDCT screening; 3) to empower and motivate patients to quit smoking within the LDCT screening context.; The decision aid is a 4-page paper format with the following features: 1) LDCT screening harms and benefits information, written in plain language and using pictographs, easily understood by those with low health literacy; 2) prompts to clarify patient values and preferences and to stimulate discussion about trade-offs; 3) clear quit smoking messaging and resources (1-800-QUIT-NOW).; A informational brochure developed by the BMC screening program about low dose CT screening for lung cancer.
Other intervention name(s): Shared decision making
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: CT low dose; nurse led intervention; safety net hospital; lung cancer screening with CTLD