The importance of co-located, high intensity smoking cessation support within lung cancer screening: Findings from the Process Evaluation of the Yorkshire Enhanced Stop Smoking study

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ABSTRACT Objective Process evaluation of the Yorkshire Enhanced Stop Smoking (YESS) study intervention, to provide evidence regarding optimal integration of smoking cessation support within lung cancer screening (LCS). Design Mixed-methods process evaluation. Setting YESS was a Randomised Controlled Trial testing the effect of personalised smoking cessation support, integrated within LCS. YESS study participants were recruited from the Yorkshire Lung Screening Trial. Participants/data collection Semi-structured interviews with 45 trial participants and eight SCPs 4, 12 and 52-weeks after screening (participants) or training (SCPs). Thematic analysis to assess intervention exposure, context, contamination and theory. Observations of SCP consultations on the screening unit (n=84; 4%) and 4-weeks after screening (n=132; 13%) tested intervention fidelity. Intervention The YESS study tested opt-out, co-located standard best practice (SBP) smoking cessation support (control) versus a theory-informed personalised risk information booklet designed to increase efficacy beliefs in addition to SBP (booklet intervention), delivered by trained smoking cessation practitioners (SCPs). Results Intervention context was paramount: participants in both trial arms described benefits of co-located and ongoing high-intensity smoking cessation support, with immediate provision of pharmacotherapy. Tailored, non-judgemental care was considered key to initiating and sustaining quitting, particularly for participants at various points along their quit or those awaiting their scan result. Fidelity was high (98%) and moderate (75%) for SBP, moderate (77%) for the booklet intervention. Exposure varied by participants’ needs, including their screening results. Potential contamination was observed, with SCPs delivering elements of the booklet intervention training across both trial arms. Conclusions A personalised approach is critical to supporting smoking cessation in LCS. Harnessing the benefits of LCS for supporting cessation at the time of screening requires investment in specialist practitioners to deliver person-centred smoking cessation support. Trial registration. www.clinicaltrials.gov/study/NCT03750110 Putting research into context What is already known on the topic Integrated smoking cessation in lung cancer screening is recommended due to the additive benefits of screening participation and cessation on lung cancer mortality. Existing evidence supports the provision of higher-intensity smoking cessation interventions within lung cancer screening, such as immediate smoking cessation support at screening, with multiple sessions of behavioural counselling and/or pharmacotherapy. However, there is currently no consensus about the optimal high-intensity model to support smoking cessation using behavioural science principles within lung cancer screening. This is a major priority for research, practice and policy. What this study adds We provide evidence for the benefits of co-located and longer-term (up to 12-weeks in person and remote) person-centred support, delivered by trained specialist lung screening SCPs, regardless of trial allocation. Future implementation of smoking cessation embedded in lung screening may benefit from investment in specialist lung screening SCPs, adopting a flexible, person-centred approach to the offer and delivery of SBP smoking cessation support.

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