Improving Smoking History Documentation to Facilitate Lung Cancer Screening Utilization

ObjectivesLung cancer screening (LCS) is the only screening test incorporating behavioral risk factors into eligibility determination. However, collecting necessary smoking history data has been challenging, limiting screening uptake. In this study, we evaluated how a program coordinators detailed shared decision-making (SDM) impacted smoking data reliability. MethodsPatients who underwent a baseline screening low-dose CT between July 31, 2013, and August 25, 2023, were stratified into pre- and post-intervention cohorts. The intervention was a comprehensive pre-CT smoking history assessment with SDM by an LCS program coordinator, implemented on July 31, 2017. We compared the completeness and concordance of smoking history data between clinician and patient self-report. ResultsAmong 3795 patients, 670 (18%) were pre- and 3125 (82%) were post-intervention. Having a coordinator reduced missing smoking data (p<0.001), but did not eliminate it. Both groups showed high concordance between clinician-documented and self-reported smoking status (pre: kappa=0.84, 95% confidence interval [CI] 0.79-0.89; post: kappa=0.84, 95% CI 0.83-0.86). Correlations strengthened for smoking duration (rho=0.71 vs. 0.65, p=0.026) and years since quitting (rho=0.83 vs. 0.80, p=0.21) after involving a coordinator. Correlations for smoking intensity and pack years remained fair (rho<0.6). LCS eligibility based on self-reported smoking history increased from 46.0% (308/670) pre- to 64.1% (2003/3125) post-intervention, below the 100% eligibility using clinician-documented history. ConclusionsSmoking data reliability improved after a dedicated LCS program coordinator implemented a smoking history assessment. Meanwhile, challenges remained with the ascertainment of total pack-years. Detailed probing and patient education may be insufficient to overcome challenges in assessing smoking intensity.