Predictors of Enrollment of Older Smokers in Six Smoking Cessation Trials in the Lung Cancer Screening Setting: The Smoking Cessation at Lung Examination (SCALE) Collaboration.

Abstract

SIGNIFICANCE\nIncreased rates of smoking cessation will be essential to maximize the population benefit of low-dose CT screening for lung cancer. The NCI s Smoking Cessation at Lung Examination (SCALE) Collaboration includes eight randomized trials, each assessing evidence-based interventions among smokers undergoing lung cancer screening (LCS). We examined predictors of trial enrollment to improve future outreach efforts for cessation interventions offered to older smokers in this and other clinical settings.\n\n\nMETHODS\nWe included the six SCALE trials that randomized individual participants. We assessed demographics, intervention modalities, LCS site and trial administration characteristics, and reasons for declining.\n\n\nRESULTS\nOf 6,285 trial- and LCS-eligible individuals, 3,897 (62%) declined and 2,388 (38%) enrolled. In multivariable logistic regression analyses, Blacks had higher enrollment rates (OR 1.5, 95% CI 1.2,1.8) compared to Whites. Compared to NRT Only trials, those approached for NRT+prescription medication trials had higher odds of enrollment (OR 6.1, 95% CI 4.7,7.9). Regarding enrollment methods, trials using Phone+In Person methods had higher odds of enrollment (OR 1.6, 95% CI 1.2,1.9) compared to trials using Phone Only methods. Some of the reasons for declining enrollment included too busy (36.6%), not ready to quit (8.2%), not interested in research (7.7%), and not interested in the intervention offered (6.2%).\n\n\nCONCLUSION\nEnrolling smokers in cessation interventions in the LCS setting is a major priority that requires multiple enrollment and intervention modalities. Barriers to enrollment provide insights that can be addressed and applied to future cessation interventions to improve implementation in LCS and other clinical settings with older smokers.\n\n\nIMPLICATIONS\nWe explored enrollment rates and reasons for declining across six smoking cessation trials in the lung cancer screening setting. Offering multiple accrual methods and pharmacotherapy options predicted increased enrollment across trials. Enrollment rates were also greater among Blacks compared to Whites. The findings offer practical information for the implementation of cessation trials and interventions in the lung cancer screening context and other clinical settings, regarding intervention modalities that may be most appealing to older, long-term smokers.