When you look at the numbers for smoking cessation, they don’t quite match. Although most adult cigarette smokers want to quit, and more than half report having tried to quit, only 7.5% actually do. Why isn’t smoking cessation effective for these individuals? One reason may be that they didn’t have effective support. Although even brief advice from a physician can improve cessation rates, many of these patients report they had never received advice or resources to quit from their physicians.
That’s what led radiologists at the University of Chicago to create a screening consultation pilot program. During the voluntary program, radiologists spent five to 10 minutes in a consultation with patients immediately following their low-dose CT scan, showing patients their images and explaining findings of the screening. Physicians also educated them on lung cancer screening.
“We wanted not only to make sure our patients were more informed about their results, but also to see if this could be an opportunity to provide patient-centered counseling for screening follow-up and smoking cessation,” says Jonathan H. Chung, MD, at the time the vice chair of quality in the department of radiology at the University of Chicago Pritzker School of Medicine. “I think it’s essential that radiologists should be seen as equal stakeholders in patient care and on multidisciplinary healthcare teams, and lung cancer screening is a great opportunity to demonstrate our expertise and care.”
Although historically these kinds of consultations with radiologists have been rare, Chung believes radiologists add a unique touch to the conversation. “We have expertise we can share,” he says. “Most patients don’t get to see their images when they discuss the findings. Providing and interpreting the image with the patients adds a visualization that allows patients to understand their imaging in a more comprehensible and accessible manner. This becomes even more meaningful in our largely Black community, which has often lacked adequate services and resources."
Setting Up for Success
The program was a success: According to a post-survey, patients were even more interested in viewing their screening images with a radiologist for future screenings. Surveyed patients felt better informed about smoking risks and cessation methods, and all of them expressed a greater interest in committing to work toward quitting smoking. Patients were also interested in smoking cessation resources.1
“Patients felt as if they were able to take ownership — and that, combined with the personalization of viewing their own images, was really important to them,” explains Alex G. Thomas, a medical student who was the lead investigator in the program. “Most patients said they had never seen an image of their lungs before, let alone have someone explain what they were looking at.”
A big key to success was the way the physicians approached conversations, Thomas says. “It was critical that these conversations were not judgmental and were focused on education.”
Conversations began not by focusing on the patients’ smoker status, but on the patients’ lives and building rapport to make them more comfortable. “We also wanted to normalize the issue of smoking,” Thomas says. “It was important to recognize and acknowledge that quitting smoking is challenging and that many people struggle with that.”
Chung adds that it’s important not to assign blame to patients who smoke. “If you do, you make the conversation negative, which I think is counterproductive to eliciting the response you want,” he says. “You can shame people into smoking cessation, or you can make them excited about it. It is best to make it part of their healthcare journey in terms of optimizing health or prolonging their life expectancy to spend more time with family rather than by scolding them about the ‘the bad thing you’ve done.’”
That approach worked. Thomas recalls one patient was so motivated that she called a friend and asked her not to buy cigarettes for her that day as she’d previously requested.
Having the consultation immediately after screening, rather than having patients wait for results, was another added value. “One of the things we came across was that patients had a lot of anticipatory anxiety about the results,” Thomas says. “We were able to relieve some of that anxiety by showing them their results and giving them the opportunity to ask questions, versus having to wait a week or more to meet with their primary provider and have follow-up appointments."
Radiologists who want to start a similar program will need buy-in from multiple stakeholders to be successful — particularly fellow radiologists, Chung says. “If you have a key person providing consultations, that person’s productivity may decrease a little bit — probably about 10%. The other radiologists on your team will need to read a few more studies to make up for that decrease.”
It’s also important to include hospital leadership and the lung cancer screening program. Not only are they valuable resources, but it’s a good opportunity to show that you want to be a part of the healthcare team, Chung says. “You’re telling them you want to be actively involved in patient care, specifically in terms of lung cancer. It helps solidify your position as a key member of the team, especially if a program like this is successful.”
And being actively involved is something all radiologists should do, Chung says. Not only are multidisciplinary teams good for patient health, but as healthcare continues to move toward a value-based model, radiology must be seen as a peer and a key partner by both patients and colleagues, he says.
“And to do that, we can’t just be seen as an equivalent to a test or an answering machine,” Chung says. “We must be seen as true consultants, and that means interacting with patients.”