Smoking cessation services and shared decision-making practices among lung cancer screening facilities: A cross-sectional study.

Abstract

Little is known about how screening facilities are meeting the requirements for the reimbursement of lung cancer screening from the Centers for Medicare & Medicaid Services (CMS), including 1) the collection and submission of data to the CMS-approved registry (American College of Radiology [ACR] Lung Cancer Screening Registry), 2) the verification of a counseling and shared decision-making (SDM) visit having occurred as part of the written order for lung cancer screening with low-dose computed tomography, and 3) the offering of smoking cessation interventions. The authors identified facilities in a southwestern state that were listed by either the ACR Lung Cancer Screening Registry or the GO2 Foundation Centers of Excellence. To select facilities, they used 2 purposive sampling approaches: maximum variation sampling and snowball sampling. They surveyed facilities from February to November 2019. There were 87 facilities contacted, and a total of 63 facilities representing 32 counties across Texas completed the survey. Nearly all facilities used Lung-RADS to classify nodules (92%; n=58) and submitted data to a CMS-approved registry (92%; n=57). Most facilities verified that the counseling and SDM visit had occurred (86%; n=54). Although slightly more than half of the facilities reported always providing self-help cessation materials (68%; n=42), similar or higher proportions of facilities reported that they never referred smokers to onsite cessation services (68%; n=42) or quitlines (77%; n=47), provided cessation counseling (81%; n=50), or recommended medications (85%; n=52). In general, screening facilities are meeting CMS requirements for screening, but they are struggling to offer smoking cessation interventions other than providing self-help materials.