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

Abstract

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.

“It’s a decision I have to make”: Patient perspectives on smoking and cessation after lung cancer screening decisions

“…Notably, the results from this study and another were from randomized control trials for smoking cessation among patients who all underwent the LDCT, indicating that those who enrolled were already more apt to change behaviors. ( Williams et al, 2022 , Taylor et al, 2007 ) Our group and others have found that the initial LCS decision-making interaction is not a teachable moment leading to improved smoking behaviors for many patients. ( Golden et al, 2020a , Kathuria et al, 2020 , Park et al, 2014 ) We previously identified three possible mechanisms to explain this finding: 1)Patients are not able to spontaneously recognize LCS discussions as a cueing event; 2) LCS discussions do not cause a strong enough negative emotional response since a) patients do not seem to be strongly bothered by their risk of lung cancer and/or b) they do not feel any distress from stigma towards them as individuals who actively smoke; or 3) since patients already know that cigarette smoke causes lung cancer, clinicians may not use LCS to reframe as a cueing event.…”

“…( Slatore and Wiener, 2018 ) Interestingly, one study found that higher perceived risk was associated with less readiness to quit smoking, going against the teachable moment conceptual model. ( Williams et al, 2022 ) Patients seemed to understand that the likelihood of the nodule being cancerous was very low. ( Golden et al, 2020a , Balata et al, 2020 ) It could be that other health-related findings could be more influential.…”

Attitudes towards the integration of smoking cessation into lung cancer screening in the United Kingdom: A qualitative study of individuals eligible to attend

“…Indeed, research has shown that abnormal spirometry results, 28,41 abnormal screening results including the need for further tests 18,19,28 or a lung cancer diagnosis 42 may lead to increased motivation and the likelihood of cessation. Additionally, the time between registering for lung cancer screening and receipt of results is associated with increased ‘readiness to quit’, particularly among individuals attending their first screening 43 . In comparison, cessation discussions when deciding whether to have screening itself, before registering for lung cancer screening, has been viewed as unlikely to impact cessation from the perspective of both clinicians and individuals offered screening 44…”

“…Additionally, the time between registering for lung cancer screening and receipt of results is associated with increased 'readiness to quit', particularly among individuals attending their first screening. 43 In comparison, cessation discussions when deciding whether to have screening itself, before registering for lung cancer screening, has been viewed as unlikely to impact cessation from the perspective of both clinicians and individuals offered screening. 44 The caveat of potential decreased motivation resulting from receiving an 'all clear' has also been identified as a concern among screening staff 45 and the current study participants.…”

“…Additionally, the time between registering for lung cancer screening and receipt of results is associated with increased 'readiness to quit', particularly among individuals attending their first screening. 43 In comparison, cessation discussions when deciding whether to have screening itself, before registering for lung cancer screening, has been viewed as unlikely to impact cessation GROVES ET AL.…”