Inpatient Smokers and LDCT Screening Part 2
Condition: Lung Cancer Screening; Smoking Cessation
MeSH terms: Lung Neoplasms
Study type: Interventional

Summary: 
      Lung cancer suffers from large racial and socioeconomic disparities. Yet those at the highest
      risk of lung cancer death - current smokers, blacks, and individuals with low socioeconomic
      status (SES) and negative social determinants of health (SDH) - are less likely to receive
      preventive health services, including the two most effective interventions to reduce lung
      cancer mortality: tobacco dependence treatment and lung cancer screening (LCS) with low-dose
      computed tomography (LDCT). At Boston Medical Center (BMC) these preventive services are
      grossly underutilized, in part due to barriers our patients face in accessing these
      outpatient programs. Innovative approaches are needed to guide high-risk smokers to
      post-discharge early lung cancer detection services.

      The overarching goal of this study is to reduce disparities in lung cancer morbidity and
      mortality by using hospitalization at an urban safety net hospital as an opportunity to
      connect high-risk smokers to both LDCT lung cancer screening and tobacco dependence
      treatment.

      In addition to inpatient shared decision making [SDM] by an NP using a decision aid,
      screen-eligible smokers will also be connected with a community health worker (CHW) to
      facilitate access to outpatient smoking cessation counseling and LCS (CHW navigation).
    

Detailed description: 
      This study is a randomized controlled trial (RCT) among 128 hospitalized smokers at BMC (64
      participants in each of two arms), to assess the effect of inpatient SDM + CHW Navigation
      (AHRQ LDCT screening decision aid + CHW + SDM discussion + smoking cessation counseling)
      compared to Enhanced Usual Care (smoking cessation counseling + decision aid) on LDCT
      screening completion at 3 months, patient knowledge, and smoking cessation at 6 months.

      The research will meet two specific aims (SA1 and SA2).

      SA1: To address barriers to engaging smokers in prevention and early detection of lung
      cancer, a pilot RCT (Pilot Study 2) will be conducted in which screen-eligible hospitalized
      smokers will be randomized to receive inpatient sdm + CHW navigation (inpatient SDM during
      smoking cessation counseling visits + CHW navigation to coordinate outpatient tobacco
      treatment, referral to LCS, and resources to address negative social determinant of health
      that present barriers to these preventive services) or Enhanced usual care (furnishing of
      LDCT screening decision aid during inpatient smoking cessation counseling visits). Compared
      to Enhanced Usual Care, it is hypothesized that inpatient sdm + CHW navigation will increase
      the number of patients completing LCS (1° outcome) and LCS knowledge, and biochemically
      validated smoking cessation at 6 months (2° outcome).

      SA2: To collect stakeholder input to inform future implementation, Fifteen primary care
      providers (PCPs) will be interviewed to assess their impressions of the intervention,
      integration into workflow, and barriers to adoption. Fifteen smokers who received the
      intervention will be interviewed to learn their impressions of its utility and suggestions
      for improvement.
    

Intervention name(s): Smoking Cessation Counseling; Decision Aid; Shared decision making (SDM); CHW Navigation
Intervention type(s): Behavioral; Behavioral; Behavioral; Behavioral
Intervention description(s): All participants will receive inpatient smoking cessation counseling by the tobacco-trained NP. Inpatient smoking cessation counseling is the standard of care at BMC.; The AHRQ "Is Lung Cancer Screening Right for me?" patient 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 tradeoffs; 3) clear quit smoking messaging and resources (1-800-QUIT-NOW); During the smoking cessation consultation, the nurse practitioner (NP) will conduct SDM, using the 4-page AHRQ "Is Lung Cancer Screening Right for me?" decision aid as a guide. The purpose of SDM is three-fold: 1) conduct a tailored discussion on tradeoffs of LDCT screening, consistent with Centers for Medicare & Medicaid Services (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 CHW will meet with the participant after the SDM to initiate the coordination of outpatient tobacco treatment, referral to LCS, and resources to address the barriers to preventive services. The CHW will follow patients subjects in the intervention arm for 3 months to help navigate and address negative social determinants of health that are barriers to LCS and tobacco treatment. For patients who agree to screening, the CHW will schedule the appointment, arrange the transportation to appointment, and meet participant at the appointment to facilitate the screening.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Community health worker (CHW); Shared decision making (SDM); Low-dose computed tomography (LDCT)