“I Already Know That Smoking Ain’t Good for Me”

Golden, Sara E.; Ono, Sarah S.; Melzer, Anne C.; Davis, James M.; Zeliadt, Steven B.; Heffner, Jaimee L.; Kathuria, Hasmeena; Garcia-Alexander, Ginny; Slatore, Christopher G.

doi:10.1016/j.chest.2020.03.061

Cited by 15 publications

(18 citation statements)

References 30 publications

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“…It would therefore follow that understanding how LCS program design can foster positive psychosocial smoking outcomes would have important impacts on the primary goal of cessation. In addition, evidence from this review suggests that LCS, even with embedded smoking cessation interventions, is not always a teachable moment and participants need to feel “ready to quit” for cessation support to be effective 6,24 . This further emphasises the role of psychosocial outcomes in impacting smoking behaviour as part of LCS programs.…”

Section: Discussionmentioning

confidence: 93%

“…A PRISMA flow diagram of search results is presented in Figure 1 16 . Following screening, 32 articles were selected for inclusion; key characteristics are summarised in Table 2 6,17–47 . Study designs included RCTs ( n = 3), pre‐post studies ( n = 6), cross‐sectional studies ( n = 12), mixed‐methods studies ( n = 1), and qualitative studies ( n = 10).…”

Section: Resultsmentioning

confidence: 99%

“…In addition, evidence from this review suggests that LCS, even with embedded smoking cessation interventions, is not always a teachable moment and participants need to feel "ready to quit" for cessation support to be effective. 6,24 This further emphasises the role of psychosocial outcomes in impacting smoking behaviour as part of LCS programs.…”

Section: Smoking-related Psychosocial Factorsmentioning

confidence: 99%

“…This presents an opportunity for "teachable moments" for clinicians to promote smoking cessation through the screening pathway but can add another layer of psychological complexity by bringing up feelings of stigma, shame, and regret around current or former smoking behaviour. 6 In view of this, how LCS programs are designed, delivered, communicated, and implemented can have important impacts on the psychosocial experiences of participants. Existing evidence supports this position, suggesting that both LCS service design components and targeted interventions implemented along the screening pathway can influence psychosocial outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Lung cancer screening is also the only type of cancer screening where eligibility is primarily based on the behaviour of smoking tobacco. This presents an opportunity for “teachable moments” for clinicians to promote smoking cessation through the screening pathway but can add another layer of psychological complexity by bringing up feelings of stigma, shame, and regret around current or former smoking behaviour 6 . In view of this, how LCS programs are designed, delivered, communicated, and implemented can have important impacts on the psychosocial experiences of participants.…”

Section: Introductionmentioning

confidence: 99%

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Lung cancer screening program factors that influence psychosocial outcomes: A systematic review

McFadden,

Rankin,

Nickel

et al. 2023

Psycho-Oncology

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ObjectivesLung cancer screening (LCS) programs are being designed and implemented globally. Early data suggests that the psychosocial impacts of LCS are influenced by program factors, but evidence synthesis is needed. This systematic review aimed to elucidate the impact of service‐level factors on psychosocial outcomes to inform optimal LCS program design and future implementation.MethodsFour databases were searched from inception to July 2023. Inclusion criteria were full‐text articles published in English that reported an association between any program factors and psychosocial outcomes experienced during LCS. Study quality was appraised, and findings were synthesised narratively.ResultsThirty‐two articles were included; 29 studies were assessed at high or moderate risk of bias. Study designs were RCT (n = 3), pre‐post (n = 6), cross‐sectional (n = 12), mixed‐methods (n = 1), and qualitative (n = 10) studies, and conducted primarily in the USA (n = 25). Findings suggested that targeted interventions can improve smoking‐related or decisional psychosocial outcomes (e.g., smoking cessation interventions increase readiness/motivation to quit) but impacts of interventions on other psychological outcomes were varied. There was limited evidence reporting association between service delivery components and psychological outcomes, and results suggested moderation by individual aspects (e.g., expectation of results, baseline anxiety). Opportunities for discussion were key in reducing psychological harm.ConclusionsCertain program factors are reportedly associated with psychosocial impacts of LCS, but study heterogeneity and quality necessitate more real‐world studies. Future work should examine (a) implementation of targeted interventions and high‐value discussion during LCS, and (b) optimal methods and timing of risk and result communication, to improve psychosocial outcomes while reducing time burden for clinicians.

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Section: Discussionmentioning

confidence: 93%

Section: Resultsmentioning

confidence: 99%

Section: Smoking-related Psychosocial Factorsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Lung cancer screening program factors that influence psychosocial outcomes: A systematic review

McFadden,

Rankin,

Nickel

et al. 2023

Psycho-Oncology

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Participant factors associated with psychosocial impacts of lung cancer screening: A systematic review

McFadden,

Nickel,

Rankin

et al. 2024

Cancer Medicine

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BackgroundPsychosocial impacts of lung cancer screening (LCS) can cause both harm to individuals and serve as barriers to screening participation and adherence. Early data suggest that the psychosocial impacts of LCS are moderated by certain factors (e.g. sociodemographic characteristics and beliefs), but evidence synthesis is lacking. This systematic review aimed to understand individual‐level risk factors for psychosocial burden during LCS as a precursor to developing strategies to identify and support participants, and improve LCS engagement.MethodsFour databases were searched for full‐text articles published in English reporting any association between participant factors and psychosocial outcomes experienced during LCS. Study quality was assessed by two independent investigators; findings were synthesised narratively. The review was pre‐registered with PROSPERO and adhered to PRISMA guidelines.ResultsThirty‐five articles were included; most (33/35) studies were assessed at high or moderate risk of bias. Study designs were pre‐post (n = 13), cross‐sectional (n = 13), qualitative (n = 8) and mixed‐methods (n = 1) and conducted primarily in the United States (n = 17). Psychological burden in LCS varied, and was often associated with younger age, female gender, current smoking status or increased smoking history, lower education, lower socio‐economic group, not being married or co‐habiting and experience with cancer. However, results were mixed, and non‐significant associations were also reported across all factors. Beliefs (e.g. fatalism, stigma and expectation of LDCT results) and comorbid psychological burden were also linked to psychosocial outcomes, but evidence was sparse. Associations between risk perception, other participant factors and other psychosocial outcomes was inconclusive, likely reflecting individual biases in risk conceptualisation.Conclusion(s)Several participant factors are consistently reported to be associated with psychosocial impacts of LCS, though study heterogeneity and high risk of bias necessitate more robust evaluation. Further research on how perceptions, beliefs and expectations can be used to improve psychosocial outcomes during LCS is needed.

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Improved motivation and readiness to quit shortly after lung cancer screening: Evidence for a teachable moment

Williams

Cordon

Eyestone

et al. 2022

Cancer

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BACKGROUND: For patients at high risk for lung cancer, screening using low-dose computed tomography (lung cancer screening [LCS]) is recommended. The purpose of this study was to examine whether screening may serve as a teachable moment for smokingrelated outcomes. METHODS: In a smoking-cessation trial, participants (N = 843) completed 2 phone interviews before randomization: before LCS (T0) and after LCS (T1). By using logistic and linear regression, the authors examined teachable moment variables (perceived risk, lung cancer worry) and outcomes (readiness, motivation, and cigarettes per day [CPD]). RESULTS: Participants were a mean ± SD age of 63.7 ± 5.9 years, had 47.8 ± 7.1 pack-years of smoking, 35.2% had a high school diploma or General Educational Development (high school equivalency) degree or less, and 42.3% were undergoing their first scan. Between T0 and T1, 25.7% of participants increased readiness to quit, 9.6% decreased readiness, and 64.7% reported no change (P < .001). Motivation to quit increased (P < .05) and CPD decreased between assessments (P < .001), but only 1.3% self-reported quitting. Compared with individuals who reported no lung cancer worry/little worry, extreme worry was associated with readiness to quit in the next 30 days (odds ratio, 1.8; 95% CI, 1.1-3.0) and with higher motivation (b = 0.83; P < .001) at T1. Individuals undergoing a baseline (vs annual) scan were more ready to quit in the next 30 days (odds ratio, 1.8; 95% CI, 1.3-2.5). CONCLUSIONS: During the brief window between registering for LCS and receiving the results, the authors observed that very few participants quit smoking, but a significant proportion improved on readiness and motivation to quit, particularly among individuals who were undergoing their first scan and those who were extremely worried about lung cancer. These results indicate that providing evidence-based tobacco treatment can build upon this teachable moment.

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“I Already Know That Smoking Ain’t Good for Me”

Cited by 15 publications

References 30 publications

Lung cancer screening program factors that influence psychosocial outcomes: A systematic review

Lung cancer screening program factors that influence psychosocial outcomes: A systematic review

Participant factors associated with psychosocial impacts of lung cancer screening: A systematic review

Improved motivation and readiness to quit shortly after lung cancer screening: Evidence for a teachable moment

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