2104. Evaluating the Effect of Image-Based Counseling for Smoking Cessation: Virtual Radiology Consultations for Patient-Centered Care
Authors * Denotes Presenting Author
  1. Kayesha Hancel *; Massachusetts General Hospital
  2. Emily Achuck; Massachusetts General Hospital
  3. John Panagides; Massachusetts General Hospital
  4. Angela Frank; Massachusetts General Hospital
  5. Susan Bennett; Massachusetts General Hospital
  6. Amita Sharma; Massachusetts General Hospital
  7. Dania Daye; Massachusetts General Hospital
Smoking cessation remains the most effective method to prevent the future incidence of lung cancer in current smokers, yet only 8% of individuals who quit smoking achieve remission at 6-12 months (Creamer et al.). The purpose of this study was to evaluate the effect of outpatient virtual radiology consultations to review low-dose CT (LDCT) lung cancer screening on patient motivation to quit smoking. 

Materials and Methods:
In this IRB-approved prospective cohort study, 277 patients were recruited from a primary care division within a quaternary care referral center who met the following inclusion criteria: 1) aged 55 to 77 years with a 30 pack-year smoking history, 2) currently smoke any tobacco, 3) obtained a LDCT scan within 2 months of screening, 4) have a Lung-RADS score of 1S or 2S.  Consent was obtained from the patient and the patient’s primary care provider (PCP) by a research associate (RA). The RA administered a pre-survey containing items from the validated Q-MAT smoking cessation motivation questionnaire to assess baseline motivation for smoking cessation. The RA coordinated with a thoracic radiologist who identified a representative CT slice, and the participant’s stage of emphysema (mild, moderate, severe). The RA then created a personalized infographic indicating the severity of lung parenchymal change. Patients attended the virtual visit with the radiologist via Zoom (San Jose, CA). The visit was limited to ten minutes and was standardized to cover the presence of pulmonary nodules, emphysema, and bronchial wall thickening. At the end of the visit, the RA conducted a post-survey. A Fischer’s exact test was conducted to assess post-intervention change in survey items.

204 patients were approved for enrollment by their PCP. 21 of the 204 patients consented to enroll in the study. Of the 21 patients, 15 fully completed the study (pre- and post-survey). Data from the pre and post-survey indicated that 100% of the participants were ‘extremely likely’ to pursue LDCT screening in the upcoming year if recommended by their PCP. Analysis of patients’ average pre-survey compared to post-survey scores demonstrated a 2-point increase in Q-MAT score, indicating a trend that the study has a potential impact on likelihood to engage in smoking cessation (p = 0.287). All participants felt that enough time was spent reviewing their radiological images, with 93% agreeing that seeing the images had a positive impact on their visit experience. 93% of participants felt the visit improved their understanding of their health condition. 47% of patients reported increased anxiety regarding viewing their images.

Our results demonstrate that radiology consultations may influence patient motivation to pursue LDCT screening in the setting of current tobacco use. Future work is needed to characterize the potential impact of this intervention in a larger sample size with varied geographic and demographic factors to provide more generalized results. A new patient enrollment method needs to be adapted in order to better engage with these patients.