Capitalizing on Hospitalization to Engage Low Socioeconomic Status Smokers in Lung Cancer Screening

Matthew Spring, Vinson Cobb, Carmel Fitzgerald, Cornelia Wakeman, Ve Truong, Katrina Steiling, Karen Lasser, Renda Wiener, Hasmeena Kathuria.

Objectives: Smoking cessation and lung cancer screening (LCS) reduce lung cancer mortality. However, among the high-risk, vulnerable patient population at our safety-net hospital, LCS remains underutilized. We sought to understand whether initiating shared decision-making (SDM) for LCS during hospitalization could increase screening rates among high-risk smokers.

Methods: We assessed hospitalized patients for LCS eligibility and then randomized screen-eligible smokers to receive either Inpatient SDM (SDM by nurse practitioner) or Enhanced Usual Care (furnishing of an LCS decision aid) during inpatient smoking cessation counseling visits. For Inpatient SDM, primary care providers were notified of the patient’s decision regarding LCS. We assessed completion of LCS within 3 months post-randomization. To explore barriers to the low rates of LCS completion, we conducted semi-structured interviews with primary care providers (n=10).

Results: Of 655 patients screened for eligibility, nearly 40% were ineligible due to recent diagnostic chest CT, the most common reason for exclusion. Of the enrolled 100 patients, more than 90% desired LCS, but fewer than 10% completed LCS for each arm. Qualitative interviews showed that while most primary care providers favorably viewed our intervention, competing priorities were barriers to LCS referral.

Conclusion: While hospitalization may be an opportunity to initiate tobacco dependence treatment and engage patients in SDM about LCS, innovative approaches are needed to connect high-risk smokers to post-discharge preventative services. A second pilot study, utilizing community health workers, is currently underway.