Assessing the Effectiveness and Implementation of group based Tobacco Treatment for older individuals undergoing lung cancer screening - Lung cancer is the leading cause of U.S. cancer deaths, and cigarette smoking accounts for 80% of lung cancers. Lung cancer screening (LCS) reduces lung cancer mortality, and integrating smoking cessation into the LCS process can increase access to tobacco treatment and cessation. Screen Assist 1 (R01 CA218123) was a factorial randomized trial that tested individually delivered telehealth tobacco cessation counseling (4 sessions over 4 weeks vs 8 sessions over 12 weeks, nicotine replacement therapy (NRT) patch provision (2 vs. 8 weeks), and screening for social barriers to cessation with referral to community resources, delivered to English and Spanish speaking smokers undergoing LCS at Mass General Brigham (MGB). Participants (n=642) were older adults, who are vulnerable to loneliness, with multiple comorbidities. A longer period of counseling significantly increased quit rates at 6 months (17.3% vs 11.7%, p=.045), but duration of NRT patch did not, and only one-third of participants used social barriers screening. Study findings identified 3 strategies to build on the effectiveness of these results: 1) participants’ preference for longer counseling, 2) participants who used any cessation medication had significantly higher quit rates (16.5% vs. 4.5% p = .001), and 3) Social barrier screening identified loneliness as the most common social need. In exit interviews, many expressed a desire for both extended support and meeting other older adults trying to quit. Group visits, an increasingly popular model in primary care, may be a cost-effective strategy to promote treatment utilization (use of counseling, medication and social barrier referral) in a supportive, interactive setting to address loneliness and promote tobacco abstinence. In Screen Assist 2, a hybrid type 2 effectiveness-implementation randomized trial will compare an 8-session telehealth group visit treatment model, with 3 monthly booster sessions, to the maximal individual visit treatment delivery model from Screen Assist 1 among 496 current smokers who speak English or Spanish and are having LCS at imaging facilities at both MGB and University of Colorado Healthcare. The primary effectiveness outcome is 6-month tobacco abstinence. All participants will be provided 8 weeks of combination NRT (patch plus lozenge) and a tobacco coach will navigate patients to any additional medications of choice and SDOH screening and resource referrals. We will leverage clinical informatics to enhance implementation outcomes, including use of natural language processing to identify eligible smokers, integration of outreach videos with clinical visit reminders, and personalized weekly treatment e-reminders via participants’ preferred digital modality (portal/ texting/email). Guided by implementation frameworks, we will assess the reach, acceptability, engagement, adoption, implementation (including cost and budget impact analysis), and sustainability. Screen Assist 2 is aligned with the 2023 Cancer Plan to engage all patients at risk for cancer and deliver evidence-based preventive care. We will disseminate findings nationally to promote widespread integration of evidence-based tobacco treatment into LCS programs.
