Leveraging the Clinical Timepoints in Lung Cancer Screening to Engage Individuals in Tobacco Treatment

Budget impact analysis for implementation decision making, planning, and financing

Shelley et al. (in Accelerating integration of tobacco use treatment in the context of lung cancer screening: relevance and application of implementation science to achieving policy and practice. Transl Behav Med 2022;12:1076-1083) laid out how implementation science frameworks and methods can advance the delivery of tobacco use treatment services during lung cancer screening services, which until recently was mandated by the Centers for Medicare and Medicaid Services. Their discussion provides an important overview of the full process of implementation and highlights the vast number of decisions that must be made when planning for implementation of an evidence-based practice such as tobacco use treatment: what specific tobacco use treatment services to deliver, when to deliver those services within the lung cancer screening process, and what implementation strategies to use. The costs of implementation play a major role in decision making and are a key implementation determinant discussed in major implementation frameworks. When making decisions about what and how to implement, budget impact analyses (BIAs) can play an important role in informing decision making by helping practitioners understand the overall affordability of a given implementation effort. BIAs can also inform the development of financing strategies to support the ongoing sustainment of tobacco use treatment service provision. More attention is needed by the research community to produce high-quality, user-friendly, and flexible BIAs to inform implementation decision making in health system and community settings. The application of BIA can help ensure that the considerable time and effort spent to develop and evaluate evidence-based programs has the best chance to inform implementation practice.

Tobacco treatment specialists' knowledge, attitudes and beliefs about lung cancer screening: Potential piece of the puzzle for increasing lung cancer screening awareness

OBJECTIVES

Less than 5% of eligible U.S. individuals undergo lung cancer screening (LCS). A significant barrier is lack of awareness; more effective outreach and education strategies are needed to achieve greater population LCS uptake. Tobacco Treatment Specialists (TTSs) are an untapped resource to assist and understanding TTS knowledge and perspectives about LCS and readiness and capacity to assist is a critical first step.

METHODS

A sequential explanatory mixed-methods study design was conducted to understand LCS knowledge, attitudes, beliefs, and practices of TTSs. A cross-sectional survey (N = 147) was conducted supplemented with 3 focus groups (N = 12).

RESULTS

TTSs lacked good working knowledge about LCS in general and screening guidelines, but think it is important for their patient population and open to routinely assessing and adding this educational component into their current workflow.

CONCLUSIONS

Tobacco treatment offers a unique venue for LCS awareness and is a setting where there are experienced specialists trained in tobacco use assessment and treatment. Results highlight the unmet training needs required to facilitate integration of tobacco treatment and LCS.

PRACTICE IMPLICATIONS

TTSs are an expanding healthcare workforce. There is a strong need for current TTSs to receive additional training in the benefits of LCS.