Project ENGAGE: Training TTSs on use of a Patient Decision Aid on Lung Cancer Screening

Background: Lung cancer screening (LCS) with low-dose computed tomography has the potential to save 12,000 lives in the United States each year, but a very low proportion of people who are eligible for screening receive it. Tobacco treatment specialists (TTSs) work with many people who use tobacco and who are eligible for lung cancer screening but may not be aware of screening and may not have been engaged in making a well-informed decision about screening.

Proposed Solution to the Problem: This project will develop a new training module for TTSs to educate them on LCS and build their skills on helping their clients make well-informed decisions about screening. In producing the new module, the project team will draw on several existing resources including:

1. training materials from the PCORI funding implementation project “Implementing Patient Decision Support for Lung Cancer Screening through Tobacco Quitlines;”
2. the existing PCORI-funded patient decision aid (PDA); and
3. the existing American College of Chest Physicians (CHEST) online training “Shared Decision Making in Lung Cancer Screening.”

The PCORI-funded research study showed that a PDA can play an essential role in preparing persons who smoke to have conversations about LCS tradeoffs and make shared screening decisions. These key messages will be part of the training module for TTSs:

• TTSs can play a key role in identifying persons eligible for LCS.
• TTSs can effectively engage persons who smoke in shared decision making (SDM) about LCS, and ensure they understand the options, potential benefits, and possible harms.
• TTSs can prepare persons who smoke for conversations with a health care provider about LCS.
• By using the PDA, TTSs can have a focused, structured conversation about the benefits and harms of LCS, and explore with patients their concerns, misperceptions, and values and preferences in making a screening decision.

After production of the training module for TTSs, information will be disseminated to TTSs in the United States to make them aware of the training module, encourage them to use it, and monitor their use of it.

Objectives: The objectives are:

1. develop the training module and submit it for accreditation by month six;
2. produce the training module by month 12;
3. disseminate the training module to TTSs in months 12-24;
4. measure project outcomes by month 24; and
5. complete a sustainability plan by month 24.

Activities: The main activities are:

1. produce and gain accreditation of the new training module;
2. communicate with TTSs on availability of the new training module;
3. monitor and evaluate use of the new training module by TTSs; and
4. develop a plan to sustain the project. 

Projected Outcomes and Outputs: The desired impact is for LCS/PDA/SDM to be a commonplace and valued continuing education training for TTSs in a variety of settings, increased awareness among eligible individuals about LCS, increased agency to make an informed decision on screening in concert with trusted healthcare professionals, and increased LCS and reduced morbidity and mortality from lung cancer. The main project outputs are:

1. the new training module;
2. an outreach and engagement plan to disseminate information to TTSs and encourage their enrollment in and completion of the training module;
3. a project outcome plan to measure reach to and engagement of TTSs in the training, training completion and experience, and post-training use; and
4. a sustainability plan.

During the PCORI-funded project period, the expected outcome are to communicate accessibility of a new training module on LCS and use of the PDA in SDM to the universe of TTSs who work in the United States (approximately 3,500); engage 20-25% of them in completing the training; and measure reaction to the training, what was and was not learned, and use of the training with their clients in their tobacco treatment practice.

In the two years after the funded project period, the expected outcome is for 50% of TTSs to have completed the training module with 50% of those trained using the training with their clients.

Three or more years after the funded project period, the expected outcome is for 65% of TTSs to have completed the training module with at least 65% of those trained using the training with their clients.

Patient and Stakeholder Engagement Plan: A 10-person Advisory Group is comprised of a TTS client, scientists, professionals with expertise in training, and TTS stakeholder organizations. They will meet four times each year. Each meeting will engage Advisory Group members in discussion; gain their feedback; and come to agreement on 1) the content of the training module, 2) the application for continuing education accreditation for TTSs, 3) the outreach and engagement plan to reach and motivate TTSs, and 4) the project outcomes.

Project Collaborators: Collaborators include the University of Texas MD Anderson Cancer Center, Thomas Jefferson University, CHEST, The Association for Treatment of Tobacco Use and Dependence, the Council for Tobacco Treatment Training Programs, the North American Quitline Consortium, three TTS trainers and a client who was helped by TTSs.