Background

Lung cancer screening, for example the Targeted Lung Health Checks (TLHC) programme, may offer a teachable moment for smoking cessation.  However, despite recommendations to integrate smoking cessation during lung screening, there are no UK guidelines detailing how to implement this.  This qualitative study aimed to explore perceived barriers and facilitators to the uptake of smoking cessation treatment at lung screening by individuals who would be eligible to attend lung screening.

Method

Two face-to-face focus groups were held with current smokers (n=6), and 25 semi-structured telephone interviews were conducted with current smokers (n=20) and recent ex-smokers (n=5) aged 55-80. Participants were recruited opportunistically from four areas in the UK where lung screening was being delivered via TLHC pilots, locally funded pilots or research studies. Data were audio-recorded and analysed thematically using a framework approach.

Results

Most participants felt that smoking cessation should be offered during lung screening, regardless of intention to quit. Lung screening was described by participants as a time where individuals may be more motivated to consider or engage with smoking cessation, as attendance and results may make lung cancer risk and the opportunity to prevent it more relevant. Participants felt the approach lung screening staff use towards introducing and discussing smoking cessation could act as an important barrier or facilitator.  An authoritative and repetitive communication style was viewed as disengaging whereas collaborative, supportive approaches were emphasised as likely to promote engagement with services.  Accessibility and flexibility of smoking cessation treatment options were highlighted as important, including timing of introducing offers of support, modes of support offered, and support setting.

Conclusion

Delivering smoking cessation as part of a person-centred and flexible approach to lung screening was acceptable to screening-eligible individuals. Individual needs and preferences should be considered when incorporating smoking cessation treatment into lung screening to promote successful service engagement.

Impact statement

Our findings illustrate the key barriers and facilitators to incorporating smoking cessation treatment into lung screening services, from the perspectives of those eligible to attend, and will shape future implementation research for successful delivery during lung screening appointments.