Incorporating effective smoking cessation interventions into lung cancer screening (LCS) programs will be essential to realizing the full benefit of screening. We conducted a pilot randomized trial to determine the feasibility and efficacy of a telephone-counseling (TC) smoking cessation intervention vs. usual care (UC) in the LCS setting. In collaboration with 3 geographically diverse LCS programs, we enrolled current smokers (61.5% participation rate) who were: registered to undergo LCS, 50–77 years old, and had a 20+ pack-year smoking history. Eligibility was not based on readiness to quit. Participants completed pre-LCS (T0) and post-LCS (T1) telephone assessments, were randomized to TC (N=46) vs. UC (N=46), and completed a final 3-month telephone assessment (T2). Both study arms received a list of evidence-based cessation resources. TC participants also received up to 6 brief counseling calls with a trained cessation counselor. Counseling calls incorporated motivational interviewing and utilized the screening result as a motivator for quitting. The outcome was biochemically verified 7-day point prevalence cessation at 3-months post-randomization. Participants (56.5% female) were 60.2 (SD=5.4) years old and reported 47.1 (SD=22.2) pack years; 30% were ready to stop smoking in the next 30 days. TC participants completed an average of 4.4 (SD=2.3) sessions. Using intent-to-treat analyses, biochemically verified quit rates were 17.4% (TC) vs. 4.3% (UC), p<.05. This study provides preliminary evidence that telephone-based cessation counseling is feasible and efficacious in the LCS setting. As millions of current smokers are now eligible for lung cancer screening, this setting represents an important opportunity to exert a large public health impact on cessation among smokers who are at very high risk for multiple tobacco-related diseases. If this evidence-based, brief, and scalable intervention is replicated, TC could help to improve the overall cost-effectiveness of LCS.

Objective To assess physicians’ attitudes regarding multiple factors that may influence recommendations for AS vs. AT given the central role physicians play in the treatment-decision making process. Methods We conducted semi-structured interviews to assess factors that physicians consider important when recommending AS vs. AT, as well as physicians’ perceptions of what their patients consider important in the decision. Participants included urologists (N=11), radiation oncologists (N=12), and primary care physicians (N=10), from both integrated and fee-for-service healthcare settings. Results Across the specialties, quantitative data indicated that most physicians reported that their recommendations for AS were influenced by patients’: older age, willingness and ability to follow a surveillance protocol, anxiety, comorbidities, life expectancy, and treatment preferences. Qualitative findings highlighted physicians’ concerns about malpractice lawsuits, given the possibility of disease progression. Additionally, most physicians noted the role of the healthcare setting, suggesting that financial incentives may be associated with AT recommendations in fee-for-service settings. Finally, most physicians reported spouse/family opposition to AS due to their own anxiety or lack of understanding of AS. Conclusions We found that patient and physician preferences, healthcare setting and family/spouse factors influence physicians’ treatment recommendations for men with low-risk PCa. These were consistent themes across physician sub-specialties in both an HMO and in fee-for-service settings.

Despite the evidence indicating that decision aids (DA) improve informed treatment decision making for prostate cancer (PCa), physicians do not routinely recommend DAs to their patients. We conducted semi-structured interviews with urologists (n = 11), radiation oncologists (n = 12) and primary care physicians (n = 10) about their methods of educating low-risk PCa patients regarding the treatment decision, their concerns about recommending DAs, and the essential content and format considerations that need to be addressed. Physicians stressed the need for providing comprehensive patient education before the treatment decision is made and expressed concern about the current unevaluated information available on the Internet. They made recommendations for a DA that is brief, applicable to diverse populations, and that fully discloses all treatment options (including active surveillance) and their potential side effects. Echoing previous studies showing that low-risk PCa patients are making rapid and potentially uninformed treatment decisions, these results highlight the importance of providing patient education early in the decision-making process. This need may be fulfilled by a treatment DA, should physicians systematically recommend DAs to their patients. Physicians' recommendations for the inclusion of particular content and presentation methods will be important for designing a high quality DA that will be used in clinical practice.

Background and Purpose: PTSD and mTBI are persistent and frequently comorbid after combat, yet current therapies often achieve only modest impact. A novel exposure-based “walk and talk” cognitive therapy, Motion-Assisted, Multi-Modal Memory Desensitization and Reconsolidation (3MDR), featuring participant-selected music and pictures and an eye movement (EM) task in an immersive virtual environment, has shown efficacy in treatment-resistant male veterans, but has not been studied in women or after TBI. The EM task is adapted from eye movement desensitization and reprocessing (EMDR) therapy, but dismantling studies of EMDR have questioned EM benefit. This pilot study assesses 3MDR in male and female veterans with comorbid PTSD and mTBI, and the impact of EM on response. We hypothesized that 3MDR would prove efficacious, both with (EM+) and without EM (EM-).Design: Participants with probable PTSD (PCL-5 ≥ 34) and mTBI were randomized to EM + or EM-across 10 sessions. Participants provided songs and pictures that they rated on impactfulness. While walking in the 3MDR virtual environment, participants started with a song to bring them back to the time of their trauma, and then traversed two hallways, actively walking toward emotionally evocative pictures that they then discussed with their therapist. Key words or feelings they expressed were superimposed over the picture, then read aloud, whereupon EM + participants recited numbers flashing on a ball crisscrossing the picture. These procedures were repeated for multiple pictures per session. A song to return the participant to present day closed each session. Change in PCL-5 score from pre-to post-intervention was the primary outcome, with additional measures at 3 and 6 months.Results: Sixteen (80%) of 20 participants completed the intervention (8 EM+, 8 EM-); 9 (6 EM+, 3 EM-) had resolution of PTSD diagnosis and two improved significantly without resolution. Average PCL-5 score declined from 52.0 (95% confidence intervals: 46.3, 57.7) at baseline to 33.6 (24.3, 42.9) post-intervention (p &lt; 0.01). The EM + group achieved statistically significant improvement (p = 0.01) while the EM-did not (p = 0.10).Conclusion: For veterans with PTSD and comorbid mTBI, 3MDR is effective, and the EM component may add value. Confirmation with larger studies is important.

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