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Jennifer A. Lewis
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P2.10 - Prevention and Tobacco Control (Not CME Accredited Session) (ID 959)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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P2.10-05 - Provider Medical Specialty Influences Smoking Cessation Counseling at an Academic Medical Center and Veterans Affairs in U.S. Mid-South (ID 12820)
16:45 - 18:00 | Presenting Author(s): Jennifer A. Lewis
- Abstract
Background
Tobacco accounts for 11.5% of deaths worldwide and approximately 30% of U.S. cancer deaths. Smoking cessation counseling using the 5 A’s (Ask, Advise, Assess, Assist, Arrange) is standard-of-care for all smokers. We tested the hypothesis that certain provider characteristics (general internal medicine [GIM], those with lung cancer screening [LCS] knowledge, and those who perceive smoking cessation as very effective) would be associated with smoking cessation counseling.
a9ded1e5ce5d75814730bb4caaf49419 Method
We surveyed all GIM, pulmonology, hematology/oncology, and gynecology providers (physicians/advanced practice providers) at a large academic institution in the Mid-South and affiliated VA from February to May 2017. The primary predictor variables were provider characteristics including: specialty, LCS guideline knowledge (high knowledge=identified start age 55, 30 pack-years, current & former smokers), and perceived effectiveness of smoking cessation, colonoscopy, and pap smear at reducing cancer mortality (very/moderately/minimally/not effective). The primary outcome was self-reported smoking cessation counseling using the 5 A’s within the past year. Data were summarized using counts, proportions, and medians. We used multivariable logistic regression adjusted for years in practice and healthcare system to evaluate the association of medical specialty with counseling. Logistic regressions of perceived effectiveness and LCS guideline knowledge as predictors of counseling were further adjusted for specialty.
4c3880bb027f159e801041b1021e88e8 Result
Of 625 providers invited, 407 (65%) responded, 378 (60.5%) questionnaires were analyzed, of which 58% were GIM, 19% hematology/oncology, 13% gynecology, 10% pulmonology. There were 255 of 350 providers (73%) who reported performing smoking cessation counseling within the past year (77% GIM vs 77% pulmonology vs 57% hematology/oncology vs 72% gynecology, χ2 p=0.013). In adjusted multivariable logistic regression, GIM (aOR 2.52 95% CI 1.40,4.54;p=0.002) and pulmonology (aOR 2.52 95% CI 1.00,6.36;p=0.05) providers were more likely to perform smoking cessation counseling than hematology/oncology providers.
41% vs 59% of those who provided counseling had high LCS knowledge vs low LCS knowledge. Fewer providers (71%) reported smoking cessation as very effective at reducing cancer-specific mortality compared to colonoscopy (77%) and pap-smear (74%). Perceived effectiveness and high LCS guideline knowledge did not predict smoking cessation counseling (aOR 1.1 95% CI 0.64,1.8;p=0.78;aOR 1.2 95% CI 0.72,2.0 p=0.47 respectively).
8eea62084ca7e541d918e823422bd82e Conclusion
Providers in general internal medicine and pulmonology were more likely than those in hematology/oncology to report performing smoking cessation counseling. Perceived effectiveness and LCS guideline knowledge did not predict smoking cessation counseling. Targeted interventions, especially in hematology/oncology, are needed to increase smoking cessation counseling using the 5 A’s. Future education should also address knowledge gaps in smoking cessation effectiveness and LCS guidelines.
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P3.11 - Screening and Early Detection (Not CME Accredited Session) (ID 977)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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P3.11-23 - Adherence to Annual Low-Dose CT Lung Cancer Screening at a Large Academic Institution (ID 12997)
12:00 - 13:30 | Author(s): Jennifer A. Lewis
- Abstract
Background
Annual low-dose computed tomography (LDCT) is standard-of-care in the high-risk population for lung cancer screening. We assessed adherence to annual LDCT screening in a large academic institution.
a9ded1e5ce5d75814730bb4caaf49419 Method
We assembled a retrospective cohort of patients who underwent LDCT between January 1, 2014 and September 30, 2016.
We included patients with baseline LungRads 1 or 2 with 12-month follow-up recommendation. We excluded those who died before the time of recommended follow-up. The time interval between the recommended follow-up study date and the actual follow-up study was calculated. Patient adherence at time of due follow-up was defined by this time interval: <=90 days (adherent) and >90 days (non-adherent).
Primary analysis was change in adherence over time. Secondary analysis included descriptive statistics of demographics.
4c3880bb027f159e801041b1021e88e8 Result
395 patients had baseline LDCT screening. We found a persistent, significant increase in adherence: 11% (2/18) in the 1st quarter 2015 and 70% (46/66) in the 3rd quarter 2017 (Pearson’s chi-squared test p=.008). We also identified racial disparity in patients enrolling in our Lung Screening Program (93% white).
8eea62084ca7e541d918e823422bd82e Conclusion
Adherence to annual LDCT screening significantly increased from 2015 to 2017. Improvement may be due to changes in national policy and/or implementation of a dedicated program physician director and program coordinator. Future work should address racial disparities and barriers to and facilitators of annual LDCT screening.
6f8b794f3246b0c1e1780bb4d4d5dc53
