An integrated digital/clinical approach to smoking cessation in lung cancer screening

Study protocol for a randomized controlled trial

Amanda L. Graham, Michael V. Burke, Megan A. Jacobs, Sarah Cha, Ivana T Croghan, Darrell R. Schroeder, James P. Moriarty, Bijan J Borah, Donna F. Rasmussen, M. Jody Brookover, Dale B. Suesse, David Eric Midthun, James Taylor Hays

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Delivering effective tobacco dependence treatment that is feasible within lung cancer screening (LCS) programs is crucial for realizing the health benefits and cost savings of screening. Large-scale trials and systematic reviews have demonstrated that digital cessation interventions (i.e. web-based and text message) are effective, sustainable over the long-term, scalable, and cost-efficient. Use of digital technologies is commonplace among older adults, making this a feasible approach within LCS programs. Use of cessation treatment has been improved with models that proactively connect smokers to treatment rather than passive referrals. Proactive referral to cessation treatment has been advanced through healthcare systems changes such as modifying the electronic health record to automatically link smokers to treatment. Methods: This study evaluates the impact of a proactive enrollment strategy that links LCS-eligible smokers with an evidence-based intervention comprised of a web-based (WEB) program and integrated text messaging (TXT) in a three-arm randomized trial with repeated measures at one, three, six, and 12 months post randomization. The primary outcome is biochemically confirmed abstinence at 12 months post randomization. We will randomize 1650 smokers who present for a clinical LCS to: (1) a usual care control condition (UC) which consists of Ask-Advise-Refer; (2) a digital (WEB + TXT) cessation intervention; or (3) a digital cessation intervention combined with tobacco treatment specialist (TTS) counseling (WEB + TXT + TTS). Discussion: The scalability and sustainability of a digital intervention may represent the most cost-effective and feasible approach for LCS programs to proactively engage large numbers of smokers in effective cessation treatment. We will also evaluate the impact and cost-effectiveness of adding proven clinical intervention provided by a TTS. We expect that a combined digital/clinical intervention will yield higher quit rates than digital alone, but that it may not be as cost-effective or feasible for LCS programs to implement. This study is innovative in its use of interoperable, digital technologies to deliver a sustainable, scalable, high-impact cessation intervention and to facilitate its integration within clinical practice. It will add to the growing knowledge base about the overall effectiveness of digital interventions and their role in the healthcare delivery system. Trial registration: ClinicalTrials.gov, NCT03084835. Registered on 9 March 2017.

Original languageEnglish (US)
Article number568
JournalTrials
Volume18
Issue number1
DOIs
StatePublished - Nov 28 2017

Fingerprint

Smoking Cessation
Early Detection of Cancer
Text Messaging
Lung Neoplasms
Randomized Controlled Trials
Withholding Treatment
Tobacco
Random Allocation
Delivery of Health Care
Costs and Cost Analysis
Cost-Benefit Analysis
Therapeutics
Referral and Consultation
Technology
Tobacco Use Disorder
Knowledge Bases
Cost Savings
Electronic Health Records
Insurance Benefits
Health Care Costs

Keywords

  • Cancer screening
  • Counseling
  • Internet
  • Lung cancer
  • Smoking cessation
  • Text messages
  • Tobacco use cessation

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Pharmacology (medical)

Cite this

An integrated digital/clinical approach to smoking cessation in lung cancer screening : Study protocol for a randomized controlled trial. / Graham, Amanda L.; Burke, Michael V.; Jacobs, Megan A.; Cha, Sarah; Croghan, Ivana T; Schroeder, Darrell R.; Moriarty, James P.; Borah, Bijan J; Rasmussen, Donna F.; Brookover, M. Jody; Suesse, Dale B.; Midthun, David Eric; Hays, James Taylor.

In: Trials, Vol. 18, No. 1, 568, 28.11.2017.

Research output: Contribution to journalArticle

Graham, Amanda L. ; Burke, Michael V. ; Jacobs, Megan A. ; Cha, Sarah ; Croghan, Ivana T ; Schroeder, Darrell R. ; Moriarty, James P. ; Borah, Bijan J ; Rasmussen, Donna F. ; Brookover, M. Jody ; Suesse, Dale B. ; Midthun, David Eric ; Hays, James Taylor. / An integrated digital/clinical approach to smoking cessation in lung cancer screening : Study protocol for a randomized controlled trial. In: Trials. 2017 ; Vol. 18, No. 1.
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abstract = "Background: Delivering effective tobacco dependence treatment that is feasible within lung cancer screening (LCS) programs is crucial for realizing the health benefits and cost savings of screening. Large-scale trials and systematic reviews have demonstrated that digital cessation interventions (i.e. web-based and text message) are effective, sustainable over the long-term, scalable, and cost-efficient. Use of digital technologies is commonplace among older adults, making this a feasible approach within LCS programs. Use of cessation treatment has been improved with models that proactively connect smokers to treatment rather than passive referrals. Proactive referral to cessation treatment has been advanced through healthcare systems changes such as modifying the electronic health record to automatically link smokers to treatment. Methods: This study evaluates the impact of a proactive enrollment strategy that links LCS-eligible smokers with an evidence-based intervention comprised of a web-based (WEB) program and integrated text messaging (TXT) in a three-arm randomized trial with repeated measures at one, three, six, and 12 months post randomization. The primary outcome is biochemically confirmed abstinence at 12 months post randomization. We will randomize 1650 smokers who present for a clinical LCS to: (1) a usual care control condition (UC) which consists of Ask-Advise-Refer; (2) a digital (WEB + TXT) cessation intervention; or (3) a digital cessation intervention combined with tobacco treatment specialist (TTS) counseling (WEB + TXT + TTS). Discussion: The scalability and sustainability of a digital intervention may represent the most cost-effective and feasible approach for LCS programs to proactively engage large numbers of smokers in effective cessation treatment. We will also evaluate the impact and cost-effectiveness of adding proven clinical intervention provided by a TTS. We expect that a combined digital/clinical intervention will yield higher quit rates than digital alone, but that it may not be as cost-effective or feasible for LCS programs to implement. This study is innovative in its use of interoperable, digital technologies to deliver a sustainable, scalable, high-impact cessation intervention and to facilitate its integration within clinical practice. It will add to the growing knowledge base about the overall effectiveness of digital interventions and their role in the healthcare delivery system. Trial registration: ClinicalTrials.gov, NCT03084835. Registered on 9 March 2017.",
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AU - Cha, Sarah

AU - Croghan, Ivana T

AU - Schroeder, Darrell R.

AU - Moriarty, James P.

AU - Borah, Bijan J

AU - Rasmussen, Donna F.

AU - Brookover, M. Jody

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AU - Hays, James Taylor

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N2 - Background: Delivering effective tobacco dependence treatment that is feasible within lung cancer screening (LCS) programs is crucial for realizing the health benefits and cost savings of screening. Large-scale trials and systematic reviews have demonstrated that digital cessation interventions (i.e. web-based and text message) are effective, sustainable over the long-term, scalable, and cost-efficient. Use of digital technologies is commonplace among older adults, making this a feasible approach within LCS programs. Use of cessation treatment has been improved with models that proactively connect smokers to treatment rather than passive referrals. Proactive referral to cessation treatment has been advanced through healthcare systems changes such as modifying the electronic health record to automatically link smokers to treatment. Methods: This study evaluates the impact of a proactive enrollment strategy that links LCS-eligible smokers with an evidence-based intervention comprised of a web-based (WEB) program and integrated text messaging (TXT) in a three-arm randomized trial with repeated measures at one, three, six, and 12 months post randomization. The primary outcome is biochemically confirmed abstinence at 12 months post randomization. We will randomize 1650 smokers who present for a clinical LCS to: (1) a usual care control condition (UC) which consists of Ask-Advise-Refer; (2) a digital (WEB + TXT) cessation intervention; or (3) a digital cessation intervention combined with tobacco treatment specialist (TTS) counseling (WEB + TXT + TTS). Discussion: The scalability and sustainability of a digital intervention may represent the most cost-effective and feasible approach for LCS programs to proactively engage large numbers of smokers in effective cessation treatment. We will also evaluate the impact and cost-effectiveness of adding proven clinical intervention provided by a TTS. We expect that a combined digital/clinical intervention will yield higher quit rates than digital alone, but that it may not be as cost-effective or feasible for LCS programs to implement. This study is innovative in its use of interoperable, digital technologies to deliver a sustainable, scalable, high-impact cessation intervention and to facilitate its integration within clinical practice. It will add to the growing knowledge base about the overall effectiveness of digital interventions and their role in the healthcare delivery system. Trial registration: ClinicalTrials.gov, NCT03084835. Registered on 9 March 2017.

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