Association of Communication With Smoking Attitudes and Behaviors Among Patients Undergoing Lung Cancer Screening: A Longitudinal Cohort Study

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.