Education on Lung Cancer Screening for Smokers

Overseen By Robert J. Volk

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: M.D. Anderson Cancer Center

Disqualifiers: Lung cancer

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

800 Participants Needed

Trial Summary

What is the purpose of this trial?

This implementation study will examine the best ways to refer heavy smokers to information about lung cancer screening.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Educational Intervention, PRE-ACT Model, Patient Navigator Model for lung cancer screening?

Research shows that interventions focusing on education and patient navigation can help improve lung cancer screening rates, especially among racially and ethnically diverse groups. Patient navigation, which involves guiding patients through the healthcare system, has been shown to reduce barriers and increase participation in lung cancer screening. ^{1 2 3 4 5}

Is the educational intervention for lung cancer screening safe for humans?

The educational intervention, including patient navigation and providing educational materials, has been used safely in studies to help people understand and participate in lung cancer screening. No safety concerns have been reported in these studies. ^{5 6 7 8 9}

How does the education on lung cancer screening for smokers differ from other treatments for lung cancer?

This treatment is unique because it focuses on educating smokers about lung cancer screening, using patient navigation and community-based educational interventions to increase awareness and adherence to screening, rather than directly treating lung cancer itself. It aims to improve screening rates and reduce fear and worry about lung cancer, which is different from traditional treatments that focus on medical or surgical interventions for diagnosed cancer. ^{10 11 12 13 14}

Research Team

Robert J. Volk

Principal Investigator

M.D. Anderson Cancer Center

Eligibility Criteria

This trial is for English-speaking staff members of a quitline, aged between 55-80 years, who have smoked the equivalent of a pack a day for at least 30 years. It's also open to current smokers or those who've quit within the last 15 years. People with a history of lung cancer cannot participate.

Inclusion Criteria

I am over 18 and work for a quitline.

English-speaking

I am currently smoking or quit smoking less than 15 years ago.

Exclusion Criteria

I have been diagnosed with lung cancer.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Educational Intervention

Call center staff undergo a 60-minute educational session

1 week

1 session (in-person or virtual)

Referral and Questionnaire

Participants are referred to lung cancer screening educational materials and complete questionnaires

6 months

Questionnaires at 1 week and 6 months

Follow-up

Participants are monitored for effectiveness and reach of the educational intervention

Up to 4 years

Treatment Details

Interventions

• Educational Intervention

Trial Overview The study is testing educational interventions and surveys to determine effective methods for informing heavy smokers about lung cancer screening options through tobacco quitlines.

Participant Groups

Group I: Callers substudy (LCS educational materials, questionnaire) Experimental Treatment 2 Interventions

Participants are referred to lung cancer screening educational materials. Participants also complete questionnaires at 1 week and 6 months after referral to educational materials.

Group II: Call center staff (educational intervention) Experimental Treatment 2 Interventions

Participants undergo training consisting of a 60-minute educational session.

Who Is Running the Clinical Trial?

M.D. Anderson Cancer Center

Lead Sponsor

Trials

3,107

Recruited

1,813,000+

National Cancer Institute (NCI)

Collaborator

Trials

14,080

Recruited

41,180,000+

Findings from Research

Lung cancer screening (LCS) is effective in reducing lung cancer mortality among high-risk smokers, but its adoption is limited, especially among racially and ethnically minoritized groups, highlighting a significant health disparity.

Interventions that streamlined the LCS process at clinics were found to be the most effective, while community-level efforts focused on education showed promise in engaging minoritized populations, indicating a need for more targeted research and standardized outcomes in future studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Interventions to improve lung cancer screening among racially and ethnically minoritized groups: A scoping review. Nam, J., Krishnan, G., Shofer, S., et al.[2023]

In a study of 901 high-risk patients undergoing CT lung cancer screening, 85.7% adhered to radiologist follow-up recommendations, indicating that high adherence rates are achievable in clinical settings.

The main reasons for nonadherence included patient refusal for follow-up exams (66.7%) and difficulties in contacting patients (20.9%), highlighting areas for improvement in patient engagement and communication.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adherence to Radiology Recommendations in a Clinical CT Lung Screening Program. Alshora, S., McKee, BJ., Regis, SM., et al.[2018]

A single-page, paper-based encounter decision aid (EDA) used during shared decision-making visits for lung cancer screening significantly reduced patient decisional conflict, as indicated by a drop in the Decisional Conflict Scale score from 35.0 to 0.2 (p < 0.001).

While 28% of patients understood the mortality benefit of lung cancer screening after the visit, a much higher percentage (82%) grasped the frequency of abnormal screening results, highlighting the need for improved patient education on the mortality benefits of screening.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pilot Study of an Encounter Decision Aid for Lung Cancer Screening. Ito Fukunaga, M., Balwan, A., Janis, JA., et al.[2023]

In a survey of 75 community providers at Federally Qualified Health Centers (FQHCs) in Santa Clara County, only 22% were aware of the lung cancer screening criteria, highlighting significant knowledge gaps that may hinder effective screening in underserved populations.

Despite concerns about potential harms and logistical challenges, 75% of FQHC providers believed that low-dose computed tomography (LDCT) screening is effective, indicating a willingness to adopt screening if barriers can be addressed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An Analysis of Lung Cancer Screening Beliefs and Practice Patterns for Community Providers Compared to Academic Providers. Khairy, M., Duong, DK., Shariff-Marco, S., et al.[2023]

A randomized controlled trial involving 225 patients showed that telephone-based navigation significantly helped identify and address barriers to lung cancer screening, with personal and provider-related issues being the most common.

Provider-related barriers decreased by 80% during the screening process, indicating that patient navigation can effectively improve access to lung cancer screening, especially among minority and underserved populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessing Barriers and Facilitators to Lung Cancer Screening: Initial Findings from a Patient Navigation Intervention. Lee, SJC., Lee, J., Zhu, H., et al.[2023]

In a study of 1509 participants from diverse backgrounds, lung cancer screening with low-dose CT detected and treated cancer in 2.8% of cases, demonstrating its efficacy in early detection.

The screening had a low false-positive rate of 9.2% and resulted in very few complications, but adherence to annual screening was notably poor, with only 18.7% of participants returning for follow-up in the first year.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Quantifying Benefits and Harms of Lung Cancer Screening in an Underserved Population: Results From a Prospective Study. Erkmen, CP., Randhawa, S., Patterson, F., et al.[2023]

A qualitative study involving 10 primary care physicians and 30 patients revealed that while awareness and support for lung cancer screening with low-dose computed tomography (LCS-LDCT) have increased since Medicare coverage, there is still a lack of shared decision-making and use of decision aids, which are required by Medicare.

To improve the implementation of LCS-LDCT screening, the study suggests creating a simple, graphic-heavy decision aid to help address ongoing barriers and enhance communication between providers and patients, ultimately aiming to reduce lung cancer mortality.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Provider and patient perspectives to improve lung cancer screening with low-dose computed tomography 5 years after Medicare coverage: a qualitative study. Martinez, MC., Stults, CD., Li, J.[2022]

A study of 438 individuals in Indiana revealed that sociodemographic factors such as race, geographic location, income, and health insurance significantly influence lung cancer screening behavior.

The research identified disparities in screening participation based on race and residence, highlighting the need for targeted outreach and educational programs to improve screening rates among underrepresented groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Understanding lung cancer screening behavior: Racial, gender, and geographic differences among Indiana long-term smokers. Carter-Harris, L., Slaven, JE., Monahan, PO., et al.[2023]

A randomized trial involving 298 Maryland Tobacco Quitline callers showed that providing lung cancer screening (LCS) education through print materials led to higher engagement (75% read the materials) compared to web-based materials (61.6%).

Despite similar rates of scheduling or completing LCS between the two groups (around 43%), the study highlights that offering educational materials in preferred formats (print or web) can enhance awareness and potentially increase screening rates among eligible individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The tobacco quitline setting as a teachable moment: The Educating Quitline Users About Lung (EQUAL) cancer screening randomized trial. Webster, M., Whealan, J., Williams, RM., et al.[2023]

The Lung AIR intervention effectively increased knowledge and reduced fear about lung cancer screening among 292 participants, demonstrating its feasibility as a community-based educational program.

One-on-one phone sessions were particularly effective, leading to greater increases in participants' intention to complete screening compared to in-person group sessions, especially among those with lower income and higher smoking rates.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adapting Community Educational Programs During the COVID-19 Pandemic: Comparing the Feasibility and Efficacy of a Lung Cancer Screening Educational Intervention by Mode of Delivery. Bouchard, EG., Saad-Harfouche, FG., Clark, N., et al.[2023]

A systematic review of 10 randomized controlled trials and 3 observational studies found that smoking cessation interventions during lung cancer screening significantly increased quit rates compared to usual care, with an odds ratio of 2.01.

Intensive interventions, defined as three or more behavioral counseling sessions, were particularly effective, showing an odds ratio of 2.11 for higher quit rates compared to usual care, while non-intensive interventions did not demonstrate a significant advantage.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Strategies to deliver smoking cessation interventions during targeted lung health screening - a systematic review and meta-analysis. Williams, PJ., Philip, KE., Alghamdi, SM., et al.[2023]

In a study of 630 older participants (ages 55-74) from the National Lung Screening Trial, it was found that current smokers perceived a higher risk of lung cancer compared to former smokers, indicating a difference in risk perception based on smoking status.

Factors influencing risk perceptions included personal smoking history, emotional concerns like worry, and knowledge about the risks associated with smoking, suggesting that tailored risk communication strategies could enhance smoking cessation efforts during lung cancer screenings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Risk perceptions among participants undergoing lung cancer screening: baseline results from the National Lung Screening Trial. Park, ER., Ostroff, JS., Rakowski, W., et al.[2022]

This pragmatic trial aims to evaluate the effectiveness of telephone-based patient navigation in improving adherence to annual low-dose CT lung cancer screening among 340 adults in a medically underserved urban population, addressing barriers to screening and promoting smoking cessation.

The study will assess adherence to the screening protocol and gather patient-reported outcomes over 18 months, providing valuable insights into real-world challenges and solutions for lung cancer screening in communities with limited access to healthcare.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patient navigation for lung cancer screening in an urban safety-net system: Protocol for a pragmatic randomized clinical trial. Gerber, DE., Hamann, HA., Santini, NO., et al.[2023]

A patient navigation program significantly increased lung cancer screening rates among high-risk smokers, with 31% of those in the intervention group receiving chest CTs compared to only 17.3% in the control group.

The program also led to a higher percentage of eligible participants undergoing lung cancer screening (92% in the intervention group), resulting in a diagnosis of lung cancer in 2% of screened patients, highlighting its efficacy in early detection.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patient navigation for lung cancer screening among current smokers in community health centers a randomized controlled trial. Percac-Lima, S., Ashburner, JM., Rigotti, NA., et al.[2019]

References

1. Ireland pubmed.ncbi.nlm.nih.gov

Interventions to improve lung cancer screening among racially and ethnically minoritized groups: A scoping review. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Adherence to Radiology Recommendations in a Clinical CT Lung Screening Program. [2018]

3. England pubmed.ncbi.nlm.nih.gov

Pilot Study of an Encounter Decision Aid for Lung Cancer Screening. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

An Analysis of Lung Cancer Screening Beliefs and Practice Patterns for Community Providers Compared to Academic Providers. [2023]

5. United States pubmed.ncbi.nlm.nih.gov

Assessing Barriers and Facilitators to Lung Cancer Screening: Initial Findings from a Patient Navigation Intervention. [2023]

6. United States pubmed.ncbi.nlm.nih.gov

Quantifying Benefits and Harms of Lung Cancer Screening in an Underserved Population: Results From a Prospective Study. [2023]

7. England pubmed.ncbi.nlm.nih.gov

Provider and patient perspectives to improve lung cancer screening with low-dose computed tomography 5 years after Medicare coverage: a qualitative study. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Understanding lung cancer screening behavior: Racial, gender, and geographic differences among Indiana long-term smokers. [2023]

9. England pubmed.ncbi.nlm.nih.gov

The tobacco quitline setting as a teachable moment: The Educating Quitline Users About Lung (EQUAL) cancer screening randomized trial. [2023]

10. England pubmed.ncbi.nlm.nih.gov

Adapting Community Educational Programs During the COVID-19 Pandemic: Comparing the Feasibility and Efficacy of a Lung Cancer Screening Educational Intervention by Mode of Delivery. [2023]

11. England pubmed.ncbi.nlm.nih.gov

Strategies to deliver smoking cessation interventions during targeted lung health screening - a systematic review and meta-analysis. [2023]

12. England pubmed.ncbi.nlm.nih.gov

Risk perceptions among participants undergoing lung cancer screening: baseline results from the National Lung Screening Trial. [2022]

13. United States pubmed.ncbi.nlm.nih.gov

Patient navigation for lung cancer screening in an urban safety-net system: Protocol for a pragmatic randomized clinical trial. [2023]

14. United States pubmed.ncbi.nlm.nih.gov

Patient navigation for lung cancer screening among current smokers in community health centers a randomized controlled trial. [2019]