Lung cancer screening (LCS) at risk people is a recently established intervention to reduce lung cancer mortality. However, an estimated 30-50% of attendees are likely to be current smokers, highlighting an opportunity to embed smoking cessation interventions.
This thesis aims to identify effective strategies for delivering smoking cessation support within LCS. I present five results chapters addressing the current research gaps within these areas.
First, I conducted a systematic review and meta-analysis. This revealed moderate certainty of evidence supporting smoking cessation interventions embedded within LCS [Odds Ratio (OR): 2.11, 95% CI 1.53-2.90, p<0.001] and high certainty of evidence supporting more intensive interventions delivered within LCS [OR: 2.40, 95% CI 1.64-3.51, p< 0.001].
Secondly, I conducted a randomised controlled trial and discovered significantly higher three-month quit rates among participants who were randomised to receive telephone smoking cessation intervention (TSI) after attending an LCS compared to usual care (UC) intervention, [TSI: 21.1% vs UC: 8.9%, OR: 2.83, 95% CI 1.44-5.60].
Thirdly, I analysed long-term results from the two Quit Smoking Lung Health Intervention trials. I discovered significantly higher 12-month self-reported, and carbon monoxide (CO) verified quit rates among participants who were randomised to receive smoking cessation support (SCS) interventions compared to usual care [Self report: SCS: 20.0% vs UC: 12.8%, OR: 1.78, 95% CI 1.04-3.04], [CO verified: SCS: 12.0% vs UC: 4.7%, OR: 2.97, 95% CI 1.43-6.73].
In the fourth and fifth chapters, I present qualitative investigations into the participant experience of the intervention and barriers to accepting it. Patients reported they experienced supportive interventions, and how the LCS and past experiences influenced quit rates, as well as reporting several psychosocial barriers to accepting support.
These studies justify and highlight the importance of ensuring lung cancer screening services are delivering evidence-based smoking cessation support within their screening programmes.