Barriers and Facilitators to Engaging in Smoking Cessation Support Among Lung Screening Participants

Abstract

Introduction Embedded smoking cessation support within lung cancer screening is recommended in the UK; however, little is known about why individuals decline smoking cessation support in this setting. This study identified psychosocial factors that influence smoking cessation and quit motivation among those who declined support for quitting smoking alongside lung cancer screening. Methods Qualitative interviews conducted between August 2019 - April 2021 with thirty adults with a smoking history, recruited from the Yorkshire Lung Screening Trial. Participants had declined smoking cessation support. Verbatim interview transcripts were thematically analysed. Results Fifty percent of participants were male and the majority were from the most deprived groups. Participants reported low motivation and a variety of barriers to stopping smoking. Participants described modifiable behavioural factors that influenced their quit motivation including self-efficacy, perceived effectiveness of stop-smoking services including smoking cessation aids, risk-minimising beliefs, lack of social support, absence of positive influences on smoking and beliefs about smoking/smoking cessation. Broader contextual factors included social isolation and stigma, COVID-19 and comorbid mental and physical health conditions that deterred smoking cessation. Conclusions To encourage engagement in smoking cessation support during lung cancer screening, interventions should seek to encourage positive beliefs about the effectiveness of smoking cessation aids and increase confidence in quitting as part of supportive, person-centred care. Interventions should also acknowledge the wider social determinants of health among the lung screening-eligible population. Implications This study provides an in-depth understanding of the beliefs surrounding smoking and smoking cessation and further potential psychosocial factors that influence those attending lung cancer screening. Many of the barriers to smoking cessation found in the present study are similar to those outside of a lung screening setting however this work offers an understanding of potential facilitators that should be considered in future lung screening programmes.

The importance of co-located, high intensity smoking cessation support within lung cancer screening: Findings from the Process Evaluation of the Yorkshire Enhanced Stop Smoking study

“…We provide further evidence for the benefits of immediate 10 and high-intensity 11 smoking cessation support within LCS. Our process evaluation extends these findings to emphasise the importance of co-located services, with longer-term (up to 12 weeks) person-centred and non-judgemental support, for engaging individuals with high nicotine dependence in smoking cessation support 26 . The lack of intervention effect on quit rates observed in YESS (Murray et al, submitted 27 ) could potentially be explained by the high standard of SBP delivered four-weeks prior to, and in conjunction with the booklet intervention; in turn potentially limiting the ability of the booklet intervention to provide additive benefit.…”