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Randomized Controlled Trial
. 2015 Sep;175(9):1509-16.
doi: 10.1001/jamainternmed.2015.2391.

Primary Care Provider-Delivered Smoking Cessation Interventions and Smoking Cessation Among Participants in the National Lung Screening Trial

Elyse R Park  1 , Ilana F Gareen  2 , Sandra Japuntich  3 , Inga Lennes  4 , Kelly Hyland  1 , Sarah DeMello  5 , JoRean D Sicks  5 , Nancy A Rigotti  6
Affiliations
Randomized Controlled Trial

Primary Care Provider-Delivered Smoking Cessation Interventions and Smoking Cessation Among Participants in the National Lung Screening Trial

Elyse R Park et al. JAMA Intern Med. 2015 Sep.

Erratum in

Abstract

Importance: The National Lung Screening Trial (NLST) found a reduction in lung cancer mortality among participants screened with low-dose computed tomography vs chest radiography. In February 2015, Medicare announced its decision to cover annual lung screening for patients with a significant smoking history. These guidelines promote smoking cessation treatment as an adjunct to screening, but the frequency and effectiveness of clinician-delivered smoking cessation interventions delivered after lung screening are unknown.

Objective: To determine the association between the reported clinician-delivered 5As (ask, advise, assess, assist [talk about quitting or recommend stop-smoking medications or recommend counseling], and arrange follow-up) after lung screening and smoking behavior changes.

Design, setting, and participants: A matched case-control study (cases were quitters and controls were continued smokers) of 3336 NLST participants who were smokers at enrollment examined participants' rates and patterns of 5A delivery after a lung screen and reported smoking cessation behaviors.

Main outcomes and measures: Prevalence of the clinician-delivered 5As and associated smoking cessation after lung screening.

Results: Delivery of the 5As 1 year after screening were as follows: ask, 77.2%; advise, 75.6%; assess, 63.4%; assist, 56.4%; and arrange follow-up, 10.4%. Receipt of ask, advise, and assess was not significantly associated with quitting in multivariate models that adjusted for sociodemographic characteristics, medical history, screening results, nicotine dependence, and motivation to quit. Assist was associated with a 40% increase in the odds of quitting (odds ratio, 1.40; 95% CI, 1.21-1.63), and arrange was associated with a 46% increase in the odds of quitting (odds ratio, 1.46; 95% CI, 1.19-1.79).

Conclusions and relevance: Assist and arrange follow-up delivered by primary care providers to smokers who were participating in the NLST were associated with increased quitting; less intensive interventions (ask, advise, and assess) were not. However, rates of assist and arrange follow-up were relatively low. Our findings confirm the need for and benefit of clinicians taking more active intervention steps in helping patients who undergo screening to quit smoking.

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Conflict of interest statement

Disclosures: Dr Park is expected to receive royalties from UpToDate. Dr Rigotti has reported receiving royalties from UpToDate and working as an unpaid consultant to Pfizer Inc for smoking cessation. No other disclosures were reported.

Figures

Figure 1
Figure 1. Consort Diagram
ACRIN indicates American College of Radiology Imaging Network; NLST, National Lung Screening Trial.
Figure 2
Figure 2. Smoking Cessation Interventions for 7075 Smokers (Excluding 9 Patients Who Completed Their Follow-up in Year 5.5) at American College of Radiology Imaging Network–National Lung Screening Trial Sites With a Primary Care Physician Visit in That Study Year During the 5-Year Period After the Initial Screen
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