HOW DOES LUNG CANCER SCREENING INFLUENCE PATIENT ATTITUDES ABOUT QUITTING SMOKING? AN EXAMINATION OF PATIENT REACTIONS WHEN SCREENING IS IMPLEMENTED IN PRIMARY CARE

Purpose: To explore how smoking cessation messages can be best integrated into primary care discussions about lung cancer screening in order to ensure screening is not perceived as a substitute for cessation and to potentially use the lung cancer screening process as a smoking cessation intervention.

Methods: We conducted semi-structured interviews among a national sample of current smokers participating in the Veteran Affairs (VA) lung cancer screening clinical demonstration project, which is one of the first groups to examine the implementation lung cancer screening in the primary care setting. We developed an interview guide exploring how smoking cessation was integrated into both the initial offer for lung cancer screening, and the discussion about CT results. Targeting three change process domains of the Transtheoretical Model of Change (TMC), we hypothesized CT screening could potentially influence including consciousness-raising, emotional arousal, and self re-evaluation.To date we have approached 84 patients. Data analysis is being conducted concurrently with data collection using both inductive and deductive content analysis.

Results: To date 17 patients have agreed to participate in study interviews, and thematic saturation has not yet been reached. Initial participants expressed feeling screening was necessary because of their smoking history. In questions about benefits and risks of screening, several patients reported knowing that a small absolute number of patients would benefit, but felt very positive about the potential for them to benefit individually. Indeterminate nodule findings were perceived by some as the first step in being helped by screening, without evidence of activation of potential change process domains. For example, one patient with a small nodule commented: “I am just glad I found out what I got before it gets too bad that they can’t do anything about it.” Patients who received non-suspicious findings interpreted the clean screening result as an indication that their smoking had not caused any harm.

Conclusions: Preliminary findings suggest that CT screening as it is being discussed may be instilling smokers with confidence that screening can substantially minimize the harms of smoking. Efforts to effectively integrate smoking cessation into the screening process will likely need to overcome strong beliefs in the panacea of cancer screening.