P3.06-009 How does screening for the early detection of lung cancer facilitate smoking cessation?: a qualitative study of screened smokers

Background: There is little evidence that lung cancer screening prompts smoking cessation in screened populations overall. However, a more complex relationship is emerging where abnormal screening results appear to promote abstinence and those smokers who attend screening seem more motivated to stop smoking than those who do not. There is a need to understand how screening programs can best facilitate reductions in smoking prevalence in screening populations. We aimed to investigate in the context of lung cancer screening i) facilitators to smoking cessation and continued abstinence and ii) attitudes to cessation support. Method: A qualitative sub-study to the Early Cancer detection test Lung cancer Scotland (ECLS) trial was conducted. We examined responses to ECLS questionnaires completed pre- and post-screening to sample smokers who had made a successful attempt to stop smoking, an unsuccessful attempt to stop or no attempt to stop since screening. Participants with positive and negative screening test results were sampled. Thirty-one in-depth semi-structured face-to-face interviews were conducted to investigate wider experiences of smoking in the screening context. Audio recordings were transcribed verbatim and thematically analyzed. We present here a subset of data relating to the specific aims above. Result: Participants reported receiving a 'fright' from positive test results and reassurance from negative results, both facilitating smoking cessation. Test results were seen as objective health feedback which could not be ignored. Recipients of positive test results were further motivated to remain abstinent by the prospect of future study-related CT scans. There was evidence that some had participated in screening with the intention of stopping smoking. Screening factors often acted in combination with other facilitators, including increasing smoking stigma, and life-stage changes such as becoming a grandparent. Attitudes to cessation support combined with a screening program were mixed. Some felt they would be deterred from attending screening if they thought they would be targeted with cessation messages. Others were open to the idea of cessation support but doubted whether it could offer cessation strategies they had not already tried. Conclusion: Smoking cessation support targeted at lung cancer screening groups should take into account ways that test results can facilitate cessation attempts and the contributing social and life stage factors of older smokers. Some smokers eligible for screening may be deterred by the prospect of associated cessation interventions. Others who want to quit may have exhausted available cessation strategies and may be seeking something novel to help them quit

Determinants of motivation to quit in smokers screened for the early detection of lung cancer:a qualitative study

BACKGROUND: The promotion of smoking cessation within lung cancer screening could lead to benefits for smoking-related disease and improve cost-effectiveness of screening. Little is known about how smokers respond to lung cancer screening and how this impacts smoking behaviour. We aimed to understand how lung cancer screening influences individual motivations about smoking, including in those who have stopped smoking since screening.METHODS: Thirty one long-term smokers aged 51-74 took part in semi-structured interviews about smoking. They had been screened with the EarlyCDT-Lung Test (13 positive result; 18 negative) as part of the Early Cancer Detection Test Lung Cancer Scotland Study. They were purposively sampled for interview based on their self-reported post-screening smoking behaviour. Eleven participants had stopped smoking since screening. Verbatim interview transcripts were analysed using thematic analysis.RESULTS: Two key overarching themes were interpretations of screening test results and emotional responses to those interpretations. Participants' understanding of the risk implied by their test result was often inaccurate, for example a negative result interpreted as an 'all-clear' from lung cancer and a positive result as meaning lung cancer would definitely develop. Those interpretations led to emotional responses (fear, shock, worry, relief, indifferSaveence) influencing motivations about smoking. Other themes included a wake-up call causing changes in perceived risk of smoking-related disease, a feeling that now is the time to stop smoking and family influences. There was no clear pattern in smoking motivations in those who received positive or negative test results. Of those who had stopped smoking, some cited screening experiences as the sole motivation, some cited screening along with other coinciding factors, and others cited non-screening reasons. Cues to change were experienced at different stages of the screening process. Some participants indicated they underwent screening to try and stop smoking, while others expressed little or no desire to stop.CONCLUSIONS: We observed complex and individualised motivations about smoking following lung cancer screening. To be most effective, smoking cessation support in this context should explore understanding of screening test results and may need to be highly tailored to individual emotional responses to screening.</p

Unconditional and conditional monetary incentives to increase response to mailed questionnaire : a randomised controlled study within a trial (SWAT)

Rationale, aims, and objectives: High response rates to research questionnaires can help to ensure results are more representative of the population studied and provide increased statistical power, on which the study may have been predicated. Improving speed and quality of response can reduce costs.Method: We conducted a randomised Study Within A Trial (SWAT) to assess questionnaire response rates, reminders sent and data completeness with unconditional compared to conditional monetary incentives. Eligible individuals were mailed a series of psychological questionnaires as a follow-up to a baseline host trial questionnaire. Half received a £5 gift voucher with questionnaires (unconditional) and half were promised the voucher after returning questionnaires (conditional).Results: Of 1079 individuals, response rates to the first follow-up questionnaire were 94.2% and91.7% in the unconditional and conditional monetary incentive groups respectively (OR 1.78, 95% CI0.85 to 3.72). There were significantly greater odds of returning repeat questionnaires in the unconditional group at six months (OR 2.97, 95% CI 1.01 to 8.71; p = 0.047) but not at 12 months(OR 1.12, 95% CI 0.44 to 2.85). Incentive condition had no impact at any time point on the proportion of sent questionnaires that needed reminders. Odds of incomplete questionnaires were significantly greater at three months in the unconditional compared to the conditional incentive group (OR 2.45, 95% CI 1.32 to 4.55; p = 0.004).Conclusions: Unconditional monetary incentives can produce a transitory greater likelihood of mailed questionnaire response in a clinical trial participant group, consistent with the direction of effect in other settings. However, this could have been a chance finding. The use of multiple strategies to promote response may have created a ceiling effect. This strategy has potential to reduce administrative and postage costs, weighed against the cost of incentives used, but could risk compromising the completeness of data

Optimising recruitment to a lung cancer screening trial: a comparison of general practitioner and community-based recruitment

No abstract available