Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Department of Sociology, Portland State University, Portland, OR.
Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Department of Family Medicine, Oregon Health & Science University, Portland, OR.
Chest. 2020 Sep;158(3):1250-1259. doi: 10.1016/j.chest.2020.03.061. Epub 2020 Apr 15.
Lung cancer screening (LCS) is now recommended for people at high risk of dying of lung cancer.
The purpose of this study was to use the LCS decision discussion as a case study to understand possible underlying components of a teachable moment to enhance motivation for smoking cessation.
The study investigated how patients and clinicians communicate about smoking. In-depth, semi-structured interviews were performed of the experiences of 51 individuals who formerly or currently smoked who were offered LCS and 24 clinicians. Only the baseline interviews were used because including the follow-up interviews would have been beyond the scope of this article. The interviews focused on communication about smoking, the perceived importance of discussing smoking and screening together, and patients' perceived challenges to smoking cessation.
Patients and clinicians differed in their views on the role of the LCS decision discussion as a teachable moment. Although clinicians felt that this discussion was a good opportunity to positively influence smoking behaviors, neither patients nor clinicians perceived the discussion as a teachable moment affecting smoking behaviors. Other motivating factors for smoking cessation were found.
Our findings indicate that LCS decision discussions are not currently a teachable moment for behavior change in smoking cessation, but perhaps clinicians could address other aspects of communication to enhance motivation for cessation. Our hypothesized teachable moment model helps explain that there may not be sufficient emotional response elicited during the discussion to motivate a major behavior change such as smoking cessation.
肺癌筛查（LCS）现在被推荐用于那些有较高肺癌死亡风险的人群。
本研究的目的是将 LCS 决策讨论作为一个案例研究，以了解增强戒烟动机的可教时刻的潜在组成部分。
该研究调查了患者和临床医生如何沟通吸烟问题。对 51 名曾或目前吸烟、接受 LCS 检查的患者和 24 名临床医生进行了深入的半结构化访谈。仅使用了基线访谈，因为包括随访访谈将超出本文的范围。访谈重点是关于吸烟的沟通、一起讨论吸烟和筛查的重要性以及患者对戒烟的感知挑战。
患者和临床医生对 LCS 决策讨论作为可教时刻的作用存在不同看法。尽管临床医生认为这次讨论是一个积极影响吸烟行为的好机会，但无论是患者还是临床医生都没有将其视为影响吸烟行为的可教时刻。还发现了其他促进戒烟的动机因素。
我们的研究结果表明，目前 LCS 决策讨论不是戒烟行为改变的可教时刻，但也许临床医生可以解决沟通的其他方面，以增强戒烟的动机。我们假设的可教时刻模型有助于解释，在讨论过程中可能没有引起足够的情感反应来激发像戒烟这样的重大行为改变。
