This grant is a quality improvement initiative that seeks to address health disparities in access to cessation treatment and lung cancer screening for underserved patients.
There are significantly higher rates of smoking among DC residents who are Black (22%) compared to white (7%) and Black individuals are less likely to receive evidence-based cessation treatments and to undergo lung cancer screening (which reduces mortality due to lung cancer by 20%).
This initiative will help to modify the electronic health record (EHR) to systematically identify and refer individuals who are currently smoking to evidence-based tobacco treatment through e-referral to the DC tobacco quitline and to refer eligible adults to undergo lung cancer screening (LCS) using low-dose CT (LDCT).
The Smoking Treatment and Recovery (STAR) Program, offered to hematology and oncology patients at MedStar Washington Hospital Center and MedStar Georgetown University Hospital, consists of four counseling sessions with a trained Tobacco Treatment Specialist. Patients also have the option to consult with a collaborating nurse practitioner regarding available medication options.
The counseling sessions utilize a motivational interviewing approach and are conducted over the phone or through scheduled telehealth visits.
In addition to counseling, the program offers patients information about smoking cessation medications as well as nicotine patches, lozenges, and/or prescriptions to help them quit.
The study targets provider and patient behavior in order to address disparities between African American patients and white patients in lung screening awareness and utilization.
We are partnering with MedStar primary care clinics to implement a multilevel intervention that includes a prompt sent to providers prior to scheduled visits with screening-eligible participants and an outreach specialist who will educate those participants about lung cancer screening.
We will test the impact of the intervention on provider-patient communication, screening intentions, and knowledge as well as screening referrals and completion.
To extend our prior work (CA R01207228), we will conduct a health system-level, pragmatic, randomized trial to compare two evidence-based cessation treatments, designed to reduce barriers to reach, improve intervention engagement, and increase treatment effectiveness. Addressing these barriers is particularly important among underserved groups (e.g., racial and ethnic minority groups, patients not ready to quit) who are less likely to receive cessation treatment.
The aims of this study are:
1) To compare e-referral to the tobacco quitline vs. a centralized health system smoking cessation intervention as assessed through biochemically verified abstinence.
2) To evaluate reach and engagement overall and by subgroup (e.g., race and ethnicity, underinsured, readiness to quit) using mixed-methods to understand the contextual factors related to the feasibility and acceptability of the interventions.
3) To conduct an economic analysis to evaluate costs, average and incremental cost per quit, and budget impact of the intervention at 3- and 6-months from the health system perspective.
We are currently conducting a pilot study and aim to recruit 50 patients scheduled at one of 6 lung cancer screening sites at MedStar Health.
During the first phase of the pilot study, our team invited patients to participate in the centralized, opt-out MedStar health system phone-based cessation intervention, adapted and improved from our prior trial.
During the second phase of the pilot study, our team is inviting patients to participate in the e-referral to the tobacco quitline intervention.
The outcomes of the pilot include the percent enrolled, the percent engaged in the treatment, and the process variables associated with delivering the interventions.
Enrollment for the full study is scheduled to begin in September, 2023.
Lung cancer disproportionately affects people with HIV (PWH) due to late-stage diagnosis and poorer lung cancer survival than the general population.
HIV status is not considered in current lung cancer screening risk assessment tools, even though it is an independent risk factor for lung cancer after adjusting for age and smoking status.
The aims of this project include:
Modifying the PLCOm2012 model to include HIV-related parameters and evaluate the performance characteristics of the PLCOm2012 HIV-adapted model.
Performing preliminary validation of the PLCOm2012 HIV-adapted model
The outcomes of this project could inform lung screening guidelines, future decision tools, and personalize strategies to the unique risks for lung cancer among PWH.
This study was funded by the National Cancer Institute as part of the Smoking Cessation at Lung Examination (SCALE) collaboration. The purpose of the study was to investigate the effectiveness of smoking cessation telephone counseling in the lung cancer screening setting.
To learn more about the study’s findings please see this Lombardi press release or read the publications featured below.
This supplement aimed to develop effective, clinic-based methods to increase rates of lung cancer screening among African American individuals.
We developed a self-directed 30-minute Health Disparities and Lung Cancer Screening course (HD) designed for primary care providers and tested the impact of pairing this course with the existing National Training Network Lung Cancer Screening course (LuCa) on providers’ knowledge of lung cancer screening and the associated health disparities.
This study compares two methods of distributing information on lung cancer screening to quitline callers: a printed booklet, and a website (shouldiscreen.com). See the Resources page for more information.
We partnered with the Maryland Tobacco Quitline to recruit callers who met criteria for lung cancer screening. We also partnered with a team from the University of Michigan who created the ShouldIScreen website.
Primary outcomes of this study are lung cancer screening knowledge and intentions to undergo screening.
This study has now completed participant enrollment and follow-up. We are currently in the process of analyzing data for publication.
