Implementing Patient Decision Support for Lung Cancer Screening through Tobacco Quitlines

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PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.

This PCORI-funded implementation project is expanding the use of a tested patient decision aid. The decision aid helps people who smoke and are at high risk for lung cancer make screening decisions and be more prepared to discuss screening with their health provider.
Screening for lung cancer for current and former heavy smokers ages 55–77 could prevent more than 12,000 deaths each year. But screening has harms as well as benefits. Possible harms include procedures to follow up a false positive test or a tumor that is not dangerous, and radiation exposure from the screening test, a CT scan.

Implementation Project Summary

What is the goal of this implementation project?

Screening can reduce deaths from lung cancer among heavy smokers, who are at high risk for developing lung cancer. But screening also has possible harms. A PCORI-funded study tested a video-based decision aid about lung cancer screening for people who seek help quitting smoking through tobacco quitlines. People who used the decision aid had a better understanding of their options and the trade-offs. They also felt more prepared to talk about screening with their health provider. Many went on to be screened.

This project will expand the use of this decision aid among smokers at high risk for lung cancer who call state tobacco quitlines. Quitlines provide counseling and other support to quit smoking.

What will this project do?

The project team is rolling out a program to train 300 staff at eight state tobacco quitlines. The program teaches staff to identify callers who are eligible for lung cancer screening and refer them to the decision aid.

The project team is

  • Developing a website that quitlines can use as a resource for callers. The website includes the decision aid and materials callers can use to talk about screening with their health providers.
  • Creating materials to help trained staff identify eligible and interested callers and discuss screening with them.
  • Visiting sites and providing ongoing support to these staff.

The project team is also creating a best practices guide. Other quitline service providers and state health agencies that fund quitlines can use this guide to support the program’s expansion.

What is the expected impact of this project?

This project will demonstrate flexible approaches that quitlines can use to support callers interested in lung cancer screening. Through this project, several thousand high-risk smokers will receive referrals to the decision aid and decision support about lung cancer screening. The project evaluation will confirm whether the program is working as intended.

The quitline service providers taking part in this project operate 37 other state quitlines. The project includes resources and guides they may use to expand the program to these other sites.

More about this implementation project:

Stakeholders Involved in This Project

  • North American Quitline Consortium
  • National Lung Cancer Roundtable of the American Cancer Society
  • State Quitline funders and service providers

Implementation Strategies

  • Adapt protocol for decision aid referral and decision aid access to work for quitline staff and workflows
  • Involve quitline center champions
  • Develop tools to support uptake of caller screening and referral protocols
  • Train quitline staff in how to use the program
  • Provide practice facilitation and ongoing consultation
  • Use audit and feedback reports

Evaluation Outcomes

To document implementation:

  • Number of callers referred to the decision aid
  • Number of callers who complete the decision aid
  • Additional measures of acceptability, fidelity of program delivery, sustainability
  • Implementation barriers and facilitators

To assess healthcare and health outcomes:

  • Referred caller’s knowledge of screening benefits and harms
  • Referred caller’s preparedness for decision making
  • Referred caller’s use of the discussion guide
  • Proportion of callers who scheduled and completed a screening

Implementation Project Details

Principal Investigator
Robert J. Volk, PhD
Other Principal Investigator
Lisa M. Lowenstein, PhD
Project Status
In progress; Recruitment not applicable
Board Approval Date
July 2019
Implementation Project Title
Implementing Patient Decision Support for Lung Cancer Screening through Tobacco Quitlines
Project End Date
December 2022
Organization
The University of Texas MD Anderson Cancer Center
Year Awarded
2019
State
Texas
Project Type
Implementation Project (Limited Competition D&I PFA)
Health Conditions  
Lung Cancer
Respiratory Diseases
Chronic Obstructive Pulmonary Disease
Funding Announcement
Implementation of PCORI-Funded Patient-Centered Outcomes Research Results (Limited PCORI Funding Announcement)
Project Budget *  
$1,376,183

*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.

Initial PCORI-funded Research Study

This implementation project focuses on putting findings into practice from this completed PCORI-funded research study: A Patient Decision Aid to Help Heavy Smokers Make Decisions about Lung Cancer Screening

Page Last Updated: 
February 1, 2021