Factors Associated With Receipt of Tobacco Treatment Integrated With Nurse Navigation in a Centralized Lung Cancer Screening Program at an Urban Academic Medical Center

Purpose: Optimal approaches for tobacco treatment counseling among individuals who currently smoke and are undergoing shared decision-making (SDM) and lung cancer screening (LCS) are unknown. The objective of this cross-sectional study was to determine the rate of reported interest in tobacco treatment counseling and pharmacotherapy among individuals who currently smoke and are receiving integrated nurse navigation for LCS and tobacco treatment in a centralized LCS Program.

Methods: We identified individuals undergoing SDM through our centralized LCS Program between March 2021 and March 2022. The LCS Program tobacco treatment protocol includes counseling both in-person and via telephone during SDM, LCS results review, and an optional 4-week follow-up. Sociodemographic and clinical data for currently smoking individuals participating in LCS were extracted from the LCS Registry.

Results: Among 1034 individuals undergoing LCS through the centralized program, 605 were currently smoking and comprised the study cohort. Nearly half (49.8%) reported interest in tobacco treatment counseling and pharmacotherapy and received a personalized treatment plan. On multivariate analysis, factors significantly associated with expressing interest in treatment included African-American/Black race, higher educational attainment, and returning visit type. Among the 301 individuals expressing interest in tobacco treatment, 35 (11.6%) had documentation of self-reported smoking cessation in the electronic health record. Successful smoking cessation for any length of time was significantly associated with receiving at least one longitudinal tobacco cessation counseling telephone call.

Conclusions: In a centralized LCS Program offering tobacco treatment integrated with screening services, race, education, and visit type were significantly associated with expressing interest in tobacco treatment counseling and pharmacotherapy, while longitudinal tobacco counseling telephone calls were associated with smoking cessation. Randomized controlled trials are needed to test whether this integrated strategy leads to LCS- and tobacco-related outcomes.