Association of Communication With Smoking Attitudes and Behaviors Among Patients Undergoing Lung Cancer Screening

Abstract

Background

Many patients who undergo lung cancer screening (LCS) actively use cigarettes.

Research Question

What are the longitudinal, patient-reported smoking attitudes and behaviors across the LCS process in routine care settings, and are these smoking attitudes and behaviors associated with patient-centered communication?

Study Design and Methods

This prospective, longitudinal, repeated measures cohort study was conducted among patients undergoing LCS in 3 health care systems. Participants were surveyed by using validated measures of smoking attitudes and behaviors and patient-centered communication domains up to 1 year following low-dose CT (LDCT) imaging for LCS. For longitudinal analyses, a series of generalized estimating equations were applied to measure the adjusted associations of overall communication quality, LCS knowledge, and decision role concordance with smoking attitudes and behaviors.

Results

A total of 253 participants who currently used cigarettes or who had recently stopped were enrolled. Of these, 83 participants (36.7% of patients with nonmissing information) had moderate or high levels of nicotine dependence. Of 133 participants who were using cigarettes at baseline who contributed data, 24 (18%) were abstinent 12 months after baseline. During the screening period, no more than 33% of participants reported receiving cessation resources from their clinician at any given point. Almost 70% of participants reported high-quality communication at baseline, which was associated with a positive stage of cigarette use behavior change (adjusted OR, 2.27; 95% CI, 1.21-4.26). Longitudinal high-quality communication was associated with cigarette abstinence (adjusted OR, 3.63; 95% CI, 1.58-8.34). LCS knowledge and decision role concordance were not associated with smoking attitudes or behaviors.

Interpretation

Our results indicate that it may be challenging to substantially improve smoking behaviors through communication strategies. Additional interventions to increase smoking cessation are required.