“每个接触点都是一个机会”：控烟专家对如何在澳大利亚肺癌筛查项目中实施戒烟干预措施的看法。
'Every Touch Point Is an Opportunity': Tobacco Control Experts' Views on How to Implement Smoking Cessation Interventions Within an Australian Lung Cancer Screening Program.
作者信息
Harrison Nathan J, Riddiford-Harland Diane, York Sarah, Marshall Henry M, Rhee Joel J, Stone Emily, Yap Mei Ling, Sharman Ashleigh R, Weber Marianne, McCullough Susan A, Byrne Terri, Paul Christine L, Bowden Jacqueline A, Bonevski Billie, Rankin Nicole M
机构信息
Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Herston, Queensland, Australia.
出版信息
Cancer Med. 2025 May;14(10):e70963. doi: 10.1002/cam4.70963.
BACKGROUND
Targeted lung cancer screening (LCS) presents unique opportunities for smoking cessation among high-risk individuals. Implementation requires consideration of context-specific determinants. We sought perspectives from tobacco control/smoking cessation experts on optimally implementing smoking cessation interventions in an Australian LCS program.
METHODS
Recruitment was via maximum variation and snowball sampling in 2022. Individual/pair interviews explored factors that may influence acceptability and feasibility, potential delivery models, and implementation strategies. We interpreted interview data using codebook thematic analysis, then mapped key topics against the Consolidated Framework for Implementation Research and previous LCS expert-identified determinants.
RESULTS
Expert participants' (N = 30) roles included program/policy managers, researchers and clinicians, working in academia, not-for-profits/peak bodies and health departments. They emphasised the benefits of integrating smoking cessation interventions into routine LCS encounters. Key barriers included perceived professional and LCS participant reluctance, stigma, and rural access. Experts discouraged duplicating current cessation resources, and suggested prioritising implementation efforts. Flexible delivery models, addressing needs of priority populations (e.g., rural/remote, culturally and linguistically diverse), were recommended. Experts generally favoured a 'hybrid' intervention pathway, combining internal and external cessation services, to maximise feasibility and uptake. Training program staff on cessation intervention delivery and leadership buy-in were emphasised as essential requirements.
DISCUSSION
In this Australian tobacco control expert sample, there was near-unanimous support for embedding cessation interventions within routine LCS delivery and capitalising on opportunities to overcome current service delivery barriers. In conjunction with LCS participant perspectives, findings are relevant to planning and implementing cessation interventions in LCS contexts.
背景
针对高危个体的肺癌筛查（LCS）为戒烟提供了独特的机会。实施需要考虑特定背景下的决定因素。我们寻求烟草控制/戒烟专家对于在澳大利亚肺癌筛查项目中最佳实施戒烟干预措施的观点。
方法
2022年通过最大变异抽样和滚雪球抽样进行招募。个人/双人访谈探讨了可能影响可接受性和可行性的因素、潜在的实施模式以及实施策略。我们使用编码本主题分析法对访谈数据进行解读，然后根据实施研究综合框架和之前肺癌筛查专家确定的决定因素对关键主题进行映射。
结果
专家参与者（N = 30）的角色包括项目/政策管理者、研究人员和临床医生，他们在学术界、非营利组织/行业组织和卫生部门工作。他们强调将戒烟干预措施纳入常规肺癌筛查流程的益处。主要障碍包括专业人员和肺癌筛查参与者的抵触情绪、耻辱感以及农村地区的可及性。专家不建议重复现有的戒烟资源，并建议优先开展实施工作。建议采用灵活的实施模式，满足优先人群（如农村/偏远地区、文化和语言多样化人群）的需求。专家普遍赞成采用“混合”干预途径，将内部和外部戒烟服务相结合，以最大限度地提高可行性和接受度。强调对项目工作人员进行戒烟干预实施培训以及获得领导层支持是必不可少的要求。
讨论
在这个澳大利亚烟草控制专家样本中，几乎一致支持将戒烟干预措施纳入常规肺癌筛查实施过程，并利用机会克服当前服务提供的障碍。结合肺癌筛查参与者的观点，研究结果与肺癌筛查背景下戒烟干预措施的规划和实施相关。
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