Putting Patient Decision Support in Place for Lung Cancer Screening through Tobacco Quitlines

This implementation project is complete.

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 worked to expand the use of a tested patient decision aid, shown to help people who smoke and are at high risk for lung cancer, make screening decisions with their doctor.
Screening for lung cancer among people ages 55–77 who currently smoke or who smoked heavily in the past 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 was the goal of this implementation project?

People who are eligible for lung cancer screening due to smoking cigarettes for many years can consider its benefits and harms when making a decision about screening. A PCORI-funded study tested a video-based decision aid about lung cancer screening among people who call tobacco quitlines. Quitlines provide counseling and support to quit smoking. People who used the decision aid better understood their options and trade-offs than those who didn’t. They also felt more prepared to talk about screening with their clinician, like a doctor or nurse. Many went on to be screened.

This project expanded the use of this decision aid among people at high risk for lung cancer due to cigarette use who call state tobacco quitlines.

What did this project do?

The project team worked with tobacco quitlines in seven states to put a lung cancer screening decision support program in place. The program identifies callers who are eligible for lung cancer screening and refers them to the decision aid. The quitlines are in Colorado, Illinois, Ohio, Oklahoma, New Hampshire, New York, and Pennsylvania.

The project team:

• Developed a website called lungscreen.health that quitlines can use as a resource for callers. The website includes the decision aid and calculators to learn lung cancer risk and screening eligibility. The website also has a guide that callers can print and use to discuss screening with their doctor.
• Designed materials to help train quitline staff to identify eligible and interested callers and discuss screening with them.
• Trained 382 quitline staff using webinars.
• Visited quitline sites and provided ongoing support to staff.

The project team also helped quitlines put strategies in place to strengthen referrals. Quitlines:

• Sent callers follow-up email and text messages with links to the website.
• Sent website links to people who had emailed the quitline in the past.

• Conducted a social media campaign.

In addition, quitlines updated their websites to include resources for lung cancer screening and a link to the lungscreen.health site.

What was the impact of this project?

Almost all callers who were eligible for the quitline—98%—received a referral to lungscreen.health. Quitline staff made 10,117 referrals to the website. Of these, 8,517 took place during an intake call, and 1,600 occurred by follow-up email, text message, or mail.

Referred callers made 2,489 visits to lungscreen.health. Of these visits, 697 were decision aid views and 56 were discussion guide downloads.

At one-week follow-up, among 281 callers surveyed:

• The project team found no differences in knowledge between callers who reported visiting lungscreen.health and those who did not (p=0.44). But callers who reported using one of the calculators on the website knew more about the potential benefits and harms of lung cancer screening (p=0.04) than those who didn’t visit the website.
• Those who reported visiting lungscreen.health had less conflict about their decision, were clearer about their values, and felt more supported in their decision (all p<0.05) than those who didn’t visit the website. Callers didn’t differ in their certainty about their choice, feeling informed about the choice, or the belief they had made a good decision based on whether they visited the website.

At six-month follow-up, among 171 callers surveyed:

• There were no differences in scheduling a visit to the doctor to discuss lung cancer screening or scheduling a screening, between callers who did or did not visit lungscreen.health.

• 35% reported scheduling a visit with their doctor. Of these callers, 86% discussed screening with their doctor.

• 23% scheduled a screening. Of these callers, 76% completed screening.

Of the seven quitlines, five continue to refer eligible callers to the lungscreen.health website. One, the New York quitline, stopped referring callers but is keeping resources from lungscreen.health on its own website.

The North American Quitline Consortium worked with the project team to develop a guide on how to put the program in place. Quitlines, quitline service providers, and state health agencies can use this guide to expand the program to other state quitlines. Since the guide’s release, additional states have put the program in place at their quitlines.

This project took place during the COVID-19 pandemic. Healthcare use was much lower during this time, and many lung cancer screening programs stopped offering routine screenings to patients. The project team doesn’t know how the pandemic affected callers’ interest in screening or their completion of screening.

More about this implementation project: