Project Summary

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.

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 decision aid referral strategies to work for quitlines of different sizes and with different staff, resources, and workflows.
  • Provide sites with tools to support implementation, including communication scripts, risk calculators, and resource website.
  • Provide educational materials to patients, as handout and part of decision aid.
  • Train quitline staff to use the referral strategies.
  • Provide quitlines with audit and feedback reports.
  • Identify and prepare champions at quitlines.
  • Conduct site visits.
  • Use a phased implementation approach.
  • Provide technical assistance to sites, including practice facilitation and consultation.
  • Partner with national stakeholder organization to develop plans for further program scaleup.
  • Develop a best practices guide to support further use of the decision aid referral strategies by other quitlines and service providers.

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

Journal Citations

Project Information

Robert J. Volk, PhD
Lisa M. Lowenstein, PhD
The University of Texas MD Anderson Cancer Center

Key Dates

July 2019
January 2023

Study Registration Information

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


Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
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Last updated: January 20, 2023