Journal of the American College of Radiology最新文献_第10页

Opportunities for Predicting Lung Cancer Screening Nonadherence: A Systematic Review and Meta-Analysis 预测肺癌筛查不依从的机会：系统回顾和荟萃分析

IF 5.1 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2025-12-01 DOI: 10.1016/j.jacr.2025.08.053

Yannan Lin MD, MPH, PhD , Ruiwen Ding PhD , Drew Moghanaki MD, MPH , Denise R. Aberle MD , William Hsu PhD , Ashley E. Prosper MD

Purpose

The low adherence rate to annual lung cancer screening (LCS) reduces potential mortality benefits. Interventions to improve adherence often do not consider individualized risk for nonadherence, which is vital in informing the design of tailored interventions. The authors systematically reviewed the literature and conducted a meta-analysis on predicting LCS nonadherence risk using machine learning.

Methods

The authors searched citation databases such as PubMed, Embase, and Web of Science for original studies that mentioned LCS nonadherence risk assessment between April 28, 2014, and May 8, 2025. Study characteristics, nonadherence information, and prediction model performance were extracted. The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD420251049715).

Results

Nine studies published between 2020 and 2025 were included in this systematic review, with sample sizes varying between 168 and 28,294, from various institutional settings. Four of the nine included studies reported prediction model performance, with a pooled cross-validated or internal test area under the receiver operating characteristics curve of 0.80 (95% confidence interval, 0.64-0.90) across three distinct study populations and a relatively small sample size between 168 and 2,430, with large heterogeneity detected across studies (P < .05, Cochran’s Q test; I² = 98.7%). The authors also explored the feasibility of leveraging four national databases to support future model development and validation efforts aimed at improving LCS adherence.

Conclusions

Machine learning models that can predict the individual risk for LCS nonadherence are underdeveloped. Radiologists and other stakeholders should invest in the curation of large, multicenter, national databases to facilitate the development and validation of models that identify patients who are in the greatest need of tailored interventions to improve adherence and enhance patient outcomes.

目的肺癌年度筛查（LCS）的低依从率降低了潜在的死亡率。改善依从性的干预措施通常不考虑不依从性的个体化风险，这对于设计量身定制的干预措施至关重要。作者系统地回顾了文献，并对使用机器学习预测LCS不依从风险进行了荟萃分析。方法作者检索了2014年4月28日至2025年5月8日期间提到LCS不依从性风险评估的引文数据库，如PubMed、Embase和Web of Science。提取研究特征、不依从信息和预测模型性能。该评价方案已在国际前瞻性系统评价注册（PROSPERO CRD420251049715）注册。本系统综述纳入了2020年至2025年间发表的9项研究，样本量在168至28,294之间，来自不同的机构设置。九项纳入的研究中有四项报告了预测模型的性能，在三个不同的研究群体中，受试者工作特征曲线下的交叉验证或内部测试区域为0.80(95%置信区间为0.64-0.90)，样本量相对较小，在168至2,430之间，研究之间存在较大的异质性（P < 0.05，科克伦Q检验；I2 = 98.7%）。作者还探讨了利用四个国家数据库来支持未来模型开发和验证工作的可行性，旨在提高LCS的依从性。结论预测LCS不依从个体风险的机器学习模型尚不完善。放射科医生和其他利益相关者应该投资管理大型、多中心的国家数据库，以促进模型的开发和验证，以确定最需要量身定制的干预措施的患者，以提高依从性并提高患者的预后。

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引用次数: 0

Successful Improvement in Lung Screening Enrollment for Women Undergoing Breast Screening—The CALM Study (Coordinate a Lung Screening With Mammography) 成功提高乳腺筛查妇女肺筛查入组率——CALM研究（肺筛查与乳房x光检查相协调）

IF 5.1 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2025-12-01 DOI: 10.1016/j.jacr.2025.08.007

Kim Lori Sandler MD , Caroline M. Godfrey MD, MPH , Valerie Welty PhD , Chinmay Jani MBBS , Stephen Deppen MA, PhD , Alexis Bartley Paulson MS , Shanna Joyner , Hannah Marmor MD, MPH , Grace Wallace CCRC , Lauren Hatcher MD, MBA , Landon Fike MD , Arulita Gupta MD , Padmanabh Shrikant Bhatt MBBS, BSc , Giulia Paliotti BS , Alaaeldin Ahmed MBBCh , Omar Al Omari MBBS , Lipisha Agarwal MBBS , Arashdeep Rupal MBBS , Margaret Lotz PhD , Susan E. Pories MD , Carey Conley Thomson MD, MPH

Background

Lung cancer is the leading cause of cancer-related death in women. Lung cancer screening (LCS) uptake remains low despite clear scientific evidence of benefit and recommendations for screening from leading organizations. In a previous US study, 58% of LCS-eligible women reported having a mammogram within 2 years compared with only 7.9% who underwent LCS, suggesting an opportunity to improve LCS uptake.

Study design and methods

Mammography participants from November 2019 to December 2022 at two academic hospitals (site A and site B) were evaluated for potential LCS eligibility. Outreach was conducted to potentially eligible participants and referring providers to confirm eligibility and offer LCS. Women with metastatic malignancy or already enrolled in LCS were excluded. Historical enrollment rates at each site were used to predict successful implementation of enrollment strategies. Targeted outreach was performed for 12 months at each site.

Results

Of 32,165 mammography participants reviewed, 1,569 women (4.9%) were confirmed eligible with chart review for LCS and 1,089 of the 1,569 women (69%) had not previously undergone LCS. A significant increase in total LCS examinations among women during the study period was observed at both institutions. Baseline LCS scans in women increased from 12 and 28 scans per month at the two institutions, respectively, in the prestudy period to 18 and 38 scans per month during the study period (P = .0038 and .0125, respectively). There was no corresponding significant change in baseline LCS scans among men at either institution over the same time frame.

Interpretation

Identifying women eligible for LCS through screening mammography programs is an opportunity to increase lung screening enrollment. The tactics employed identified women eligible for LCS from the screening mammography population and demonstrated a significant increase in LCS examinations in women.

背景肺癌是女性癌症相关死亡的主要原因。尽管有明确的科学证据表明肺癌筛查（LCS）有益，并有领先组织的筛查建议，但肺癌筛查（LCS）的使用率仍然很低。在美国之前的一项研究中，58%的符合LCS条件的妇女报告在2年内进行了乳房x光检查，而接受LCS的妇女只有7.9%，这表明有机会提高LCS的吸收。研究设计和方法对2019年11月至2022年12月在两家学术医院（A点和B点）进行x光检查的参与者进行潜在的LCS资格评估。对潜在的合格参与者和推荐提供者进行外展，以确认资格并提供LCS。患有转移性恶性肿瘤或已经加入LCS的女性被排除在外。每个站点的历史入学率被用来预测招生策略的成功实施。在每个地点进行了为期12个月的有针对性的外展。结果在32,165名乳房x光检查参与者中，1,569名女性（4.9%）被确认符合LCS的图表回顾，1,569名女性中有1,089名（69%）以前没有接受过LCS。在研究期间，两所机构的妇女LCS检查总数均有显著增加。女性的基线LCS扫描分别从研究前的每月12次和28次增加到研究期间的每月18次和38次（P = 0.0038和P = 0.0038）。0125年,分别)。在同一时间段内，两家机构的男性LCS基线扫描没有相应的显著变化。通过筛查乳房x光检查项目确定有资格接受LCS的妇女是增加肺部筛查登记的一个机会。所采用的策略从筛查乳房x线摄影人群中确定了符合LCS条件的妇女，并证明了妇女LCS检查的显着增加。

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引用次数: 0

Less Versus More Intensive Surveillance of Pulmonary Nodules Detected Incidentally or by Screening: A Survey of Radiologist Beliefs About Guidelines Implemented in the Watch the Spot Trial 对偶然发现的或通过筛查发现的肺结节进行更少或更密集的监测：放射科医生对观察现场试验中实施的指南的看法的调查

IF 5.1 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2025-12-01 DOI: 10.1016/j.jacr.2025.09.022

Michael K. Gould MD, MS , Beth Creekmur MA , Lihong Qi PhD , Evan de Bie , Denise R. Aberle MD , Debra S. Dyer MD , Sara Golden PhD , Celia P. Kaplan DrPH , Richard A. Mularski MD , Julie S. Steiner MA , Jennifer P. Steltz , Anil Vachani MD , Renda Soylemez Wiener MD, MPH , Karen Kelly MD , Rebecca Smith-Bindman MD , Diana L. Miglioretti PhD

Objective

To examine radiologists’ beliefs about protocols for less versus more intensive surveillance imaging in patients with small pulmonary nodules.

Methods

We developed a self-administered survey to measure familiarity, adherence, and satisfaction with assigned protocols for surveillance as implemented in an unblinded, cluster-randomized, pragmatic trial of pulmonary nodule evaluation. Protocols were modeled on recommendations from the Fleischner Society (for incidental nodules) and the ACR’s Lung CT Screening Reporting and Data System (for screening-detected nodules). We compared responses by study arm using multivariable logistic regression.

Results

The survey was completed by 153 of 514 invited radiologists (29.8%), including 76 responders in the less intensive study arm and 77 in the more intensive arm. For incidentally detected nodules, large majorities of responders in both study arms reported at least moderate familiarity (>88%) and at least very frequent adherence (>94%) with assigned protocols for surveillance, and over 70% agreed that benefits of adherence outweigh the harms. Responders in the less intensive arm were more likely to agree that their preferred guideline was in use during the study (78.9% versus 45.5%; adjusted odds ratio [aOR] 13.9, 95% confidence interval [CI] 4.2-45.7), were more likely to believe that the supporting evidence for the assigned guideline was strong or very strong (76.3% versus 54.6%; aOR 2.40, 95% CI 1.13-5.07), and were less likely to believe that follow-up recommendations were too frequent (25.0% versus 41.6%; aOR 0.46, 95% CI 0.22-0.96). For screening-detected nodules, responders in both study arms reported high levels of protocol familiarity, adherence, and agreement that benefits of adherence outweigh the harms.

Conclusion

In this pragmatic clinical trial, practicing radiologists reported high levels of familiarity, adherence, and agreement with assigned guidelines for pulmonary nodule evaluation. Perceptions of the supporting evidence and beliefs about the frequency of surveillance were more favorable in the less intensive study arm, likely reflecting radiologists’ preference for and comfort with guidelines currently in use.

目的探讨放射科医生对小肺结节患者较少或更密集的监测成像方案的看法。方法：我们开展了一项自我管理的调查，以衡量对指定监测方案的熟悉程度、依从性和满意度，该方案在一项非盲、集群随机、实用的肺结节评估试验中实施。方案以Fleischner学会（偶发结节）和ACR肺CT筛查报告和数据系统（筛查检测结节）的建议为蓝本。我们使用多变量逻辑回归比较各研究组的反应。结果514名受邀放射科医生中的153名（29.8%）完成了调查，其中76名应答者来自低强度研究组，77名应答者来自高强度研究组。对于偶然发现的结节，两个研究组中绝大多数应答者报告至少中度熟悉（>88%）和至少非常频繁地遵守（>94%）指定的监测方案，超过70%的人同意遵守的益处大于危害。低强度组的应答者更有可能同意他们首选的指南在研究期间被使用（78.9%对45.5%；调整优势比[aOR] 13.9, 95%可信区间[CI] 4.2-45.7），更有可能相信指定指南的支持证据是强的或非常强的（76.3%对54.6%;aOR 2.40, 95% CI 1.13-5.07），更不可能相信随访建议过于频繁(25.0%对41.6%；aOR 0.46, 95% CI 0.22-0.96)。对于筛查检测到的结节，两个研究组的应答者都报告了高水平的方案熟悉度、依从性，并一致认为依从性的益处大于危害。结论：在这项实用的临床试验中，执业放射科医生报告了对肺结节评估指南的高度熟悉、依从性和一致性。在不太密集的研究中，对支持证据的认知和对监测频率的信念更有利，这可能反映了放射科医生对目前使用的指南的偏好和舒适度。

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引用次数: 0

Radon and Tobacco Risk Counseling During Lung Cancer Screening Shared Decision-Making 肺癌筛查中的氡和烟草风险咨询

IF 5.1 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2025-12-01 DOI: 10.1016/j.jacr.2025.08.052

Stacy R. Stanifer PhD, APRN , Kathy Rademacher BA , Whitney Sedio MPH , Naomi Cheek MPH , Amanda Thaxton Wiggins PhD , Mary Kay Rayens PhD , Ellen J. Hahn PhD, RN

Objective

Examine frequency of tobacco and radon risk counseling during lung cancer screening shared decision making among qualified health care providers and the relationship between radon beliefs, tobacco and radon counseling self-efficacy, and related tobacco and radon risk counseling among providers.

Methods

Cross-sectional, observational study design employing a mailed self-report survey sent to a stratified random sample of 1,000 qualified health care providers in Kentucky. Regression analyses to examine the association among sociodemographic characteristics, radon beliefs, self-efficacy, familiarity with lung cancer screening guidelines, and tobacco or radon risk reduction counseling during lung cancer screening shared decision making.

Results

In all, 149 providers responded to the mailed survey (14.9% participation rate). Participants were largely unsure about their radon beliefs. Providers rated their self-efficacy for tobacco cessation counseling higher than their self-efficacy related to counseling patients on radon testing and mitigation. Participants reported a high frequency of tobacco risk counseling during lung cancer screening shared decision making, but almost never counseled on radon risk. Adjusting for health care provider demographic- and practice-level variables, self-efficacy related to tobacco cessation counseling was the sole significant predictor of frequency of tobacco risk counseling. In the multilevel logistic regression model, no variables were found to be significantly associated with frequency of radon risk counseling during lung cancer screening shared decision making.

Discussion

Risk reduction remains essential to reducing the burden of lung cancer in the United States. Interventions that increase provider beliefs about radon and provider self-efficacy in relation to tobacco and radon counseling during lung cancer screening are needed.

目的了解卫生保健人员在肺癌筛查共同决策中接受烟草和氡风险咨询的频率，以及氡信念、烟草和氡咨询自我效能感和相关烟草和氡风险咨询之间的关系。方法采用邮寄自我报告调查的横断面观察性研究设计，向肯塔基州1000名合格的卫生保健提供者分层随机抽样。回归分析以检验社会人口学特征、氡信念、自我效能、对肺癌筛查指南的熟悉程度以及肺癌筛查过程中共同决策过程中烟草或氡风险降低咨询之间的关系。结果共有149家医疗服务提供者参与了邮寄调查，参与率为14.9%。参与者大都不确定自己对氡的看法。提供者认为他们在戒烟咨询方面的自我效能高于在氡检测和缓解咨询患者方面的自我效能。参与者报告说，在肺癌筛查共同决策期间，烟草风险咨询的频率很高，但几乎从未咨询过氡风险。调整卫生保健提供者人口统计学和实践水平变量后，与戒烟咨询相关的自我效能感是烟草风险咨询频率的唯一显著预测因子。在多水平logistic回归模型中，未发现与肺癌筛查共享决策中氡风险咨询频率显著相关的变量。在美国，降低风险仍然是减少肺癌负担的关键。需要采取干预措施，提高提供者对肺癌筛查期间烟草和氡咨询方面的氡和提供者自我效能感的信念。

{"title":"Radon and Tobacco Risk Counseling During Lung Cancer Screening Shared Decision-Making","authors":"Stacy R. Stanifer PhD, APRN , Kathy Rademacher BA , Whitney Sedio MPH , Naomi Cheek MPH , Amanda Thaxton Wiggins PhD , Mary Kay Rayens PhD , Ellen J. Hahn PhD, RN","doi":"10.1016/j.jacr.2025.08.052","DOIUrl":"10.1016/j.jacr.2025.08.052","url":null,"abstract":"<div><h3>Objective</h3><div>Examine frequency of tobacco and radon risk counseling during lung cancer screening shared decision making among qualified health care providers and the relationship between radon beliefs, tobacco and radon counseling self-efficacy, and related tobacco and radon risk counseling among providers.</div></div><div><h3>Methods</h3><div>Cross-sectional, observational study design employing a mailed self-report survey sent to a stratified random sample of 1,000 qualified health care providers in Kentucky. Regression analyses to examine the association among sociodemographic characteristics, radon beliefs, self-efficacy, familiarity with lung cancer screening guidelines, and tobacco or radon risk reduction counseling during lung cancer screening shared decision making.</div></div><div><h3>Results</h3><div>In all, 149 providers responded to the mailed survey (14.9% participation rate). Participants were largely unsure about their radon beliefs. Providers rated their self-efficacy for tobacco cessation counseling higher than their self-efficacy related to counseling patients on radon testing and mitigation. Participants reported a high frequency of tobacco risk counseling during lung cancer screening shared decision making, but almost never counseled on radon risk. Adjusting for health care provider demographic- and practice-level variables, self-efficacy related to tobacco cessation counseling was the sole significant predictor of frequency of tobacco risk counseling. In the multilevel logistic regression model, no variables were found to be significantly associated with frequency of radon risk counseling during lung cancer screening shared decision making.</div></div><div><h3>Discussion</h3><div>Risk reduction remains essential to reducing the burden of lung cancer in the United States. Interventions that increase provider beliefs about radon and provider self-efficacy in relation to tobacco and radon counseling during lung cancer screening are needed.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 12","pages":"Pages 1473-1482"},"PeriodicalIF":5.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145625181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Vision Toward Risk-Stratified Postoperative Surveillance for Lung Cancer: Harnessing CT and AI 肺癌术后风险分层监测的前景：利用CT和人工智能

IF 5.1 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2025-12-01 DOI: 10.1016/j.jacr.2025.08.015

Lori C. Sakoda PhD, MPH , Florian J. Fintelmann MD , Louise M. Henderson PhD, MSPH

引用次数: 0

“You Always Worry”: Scan-Related Anxiety Among Patients With Metastatic Lung Cancer “你总是担心”：转移性肺癌患者的扫描相关焦虑

IF 5.1 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2025-12-01 DOI: 10.1016/j.jacr.2025.08.021

Heather Derry-Vick PhD , Holly G. Prigerson PhD , Jessica Hahne MA , Nina Glesby BA , Andrew S. Epstein MD , Ashish Saxena MD, PhD , Paul K. Maciejewski PhD

Purpose

Routine cancer scans (eg, CT, MRI) produce important prognostic information. However, patients may experience distressing “scanxiety” around the time of scans and scan result discussions. The aim of this study was to describe scanxiety and factors affecting it among patients with metastatic lung cancer completing disease-monitoring, postdiagnosis scans.

Methods

After a clinical appointment to discuss routine disease-monitoring scans, participants with metastatic lung cancer who were receiving first-line treatment (n = 9) completed semistructured interviews. Interviews were analyzed using qualitative thematic analysis.

Results

Qualitative analysis revealed that some patients experienced anxiety and other negative emotions around their scans, whereas others did not; patients self-managed anxiety using diverse coping strategies and by seeking out support. Participants described clinician- and clinic-based factors influencing scanxiety, including scheduling and procedural logistics, knowing what to expect, rapport with clinicians, and results delivery methods.

Conclusions

Despite the small sample, these findings suggest some, but not all, patients with metastatic lung cancer may benefit from psychosocial support while awaiting scan results and provide insight into patient-, clinician-, and clinic-level factors that may be targeted to reduce scanxiety.

目的：常规癌症扫描（如CT、MRI）可提供重要的预后信息。然而，患者可能会在扫描和扫描结果讨论期间经历痛苦的“扫描焦虑”。本研究的目的是描述完成疾病监测和诊断后扫描的转移性肺癌患者的扫描焦虑及其影响因素。方法：在临床预约讨论常规疾病监测扫描后，接受一线治疗的转移性肺癌患者（n = 9）完成了半结构化访谈。访谈采用定性专题分析进行分析。结果定性分析显示，一些患者在扫描时出现焦虑和其他负面情绪，而另一些患者则没有；患者通过不同的应对策略和寻求支持来自我管理焦虑。参与者描述了影响扫描焦虑的临床医生和基于临床的因素，包括日程安排和程序后勤、了解预期情况、与临床医生的关系以及结果交付方法。尽管样本很小，但这些发现表明，在等待扫描结果的同时，一些（但不是全部）转移性肺癌患者可能受益于心理社会支持，并为患者、临床医生和临床水平的因素提供见解，这些因素可能会减少扫描焦虑。

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引用次数: 0

Barriers and Facilitators to Accurate Smoking History and Equitable Lung Cancer Screening Uptake Among Hispanic and Latino Populations 西班牙裔和拉丁裔人群中准确吸烟史和公平肺癌筛查的障碍和促进因素

IF 5.1 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2025-12-01 DOI: 10.1016/j.jacr.2025.08.010

Lina Karout MD , Pragya Dhar MPH , Elizabeth Waldron PhD , Valeria Nunez BSc , Priya Sarin Gupta MD, MPH , Gladys Vega , Kelly E. Irwin MD, MPH , Ruth C. Carlos MD, MS , Elyse R. Park PhD, MPH , Efrén J. Flores MD

Objective

To employ a community-based qualitative study to identify multilevel barriers and facilitators to smoking disclosure, ascertainment, documentation, and lung cancer screening (LCS) referral among Hispanic and Latino communities.

Methods

This qualitative study included 38 participants (22:16, 54 ± 13 years): Hispanic and Latino patients (n = 26) eligible for LCS, community-based primary care providers (n = 7), and community-based organization leaders (n = 5). Semistructured interviews were conducted between November 2023 to October 2024, in English, Spanish, and Portuguese. Professionally transcribed and translated audio recordings were analyzed in Dedoose using a hybrid inductive-deductive qualitative analysis.

Results

Six themes emerged across three levels. Patient-level themes included (1) interpersonal and cultural reinforcement of smoking: smoking was modeled and normalized through family and social networks and (2) intrapersonal stress and life events: smoking was used for emotional regulation or cessation after major life changes. Provider-level themes included (3) gaps in provider-patient communication and trust: brief or judgmental counseling reduced patient comfort with disclosing smoking and limited accurate smoking ascertainment and (4) language and cultural incongruence: mismatches during clinical encounters disrupted meaningful dialogue, negatively impacting both ascertainment and documentation. System-level themes included (5) structural access barriers: insurance, transportation, or scheduling challenges limited engagement with cessation and LCS, disrupting documentation and follow-up and (6) underreporting in medical documentation, revealed breakdowns in electronic health record systems.

Conclusion

Barriers to accurate smoking history and LCS are complex, spanning interpersonal, cultural, linguistic, and clinician and system domains. With upcoming Healthcare Effectiveness Data and Information Set Tobacco Use Screening and Cessation Intervention implementation, improving smoking history disclosure, ascertainment, and documentation are essential for equitable LCS referral and improve lung cancer outcomes through early detection.

目的采用一项基于社区的定性研究，以确定西班牙裔和拉丁裔社区中吸烟信息披露、确定、记录和肺癌筛查（LCS）转诊的多层次障碍和促进因素。方法本定性研究包括38名参与者（22:16,54±13岁）：符合LCS条件的西班牙裔和拉丁裔患者（n = 26），社区初级保健提供者（n = 7）和社区组织领导者（n = 5）。半结构化访谈在2023年11月至2024年10月期间进行，用英语、西班牙语和葡萄牙语进行。专业转录和翻译的录音在Dedoose中使用混合归纳-演绎定性分析进行分析。结果六个主题出现在三个层面。患者层面的主题包括(1)吸烟的人际和文化强化：吸烟通过家庭和社会网络建模和规范化；(2)个人压力和生活事件：吸烟用于情绪调节或在重大生活变化后戒烟。提供者层面的主题包括：(3)提供者-患者沟通和信任的差距：简短或判断性的咨询降低了患者对披露吸烟和限制准确吸烟确定的舒适度；(4)语言和文化不一致：临床遭遇中的不匹配破坏了有意义的对话，对确定和记录产生了负面影响。系统层面的主题包括(5)结构性准入障碍：保险、运输或日程安排方面的挑战，对戒烟和LCS的参与有限，扰乱文件和后续工作；(6)医疗文件少报，揭示了电子健康记录系统的故障。结论获得准确吸烟史和LCS的障碍是复杂的，跨越人际、文化、语言、临床和系统领域。随着即将实施的医疗保健有效性数据和信息集烟草使用筛查和戒烟干预，改善吸烟史的披露、确定和记录对于公平的LCS转诊和通过早期发现改善肺癌结局至关重要。

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引用次数: 0

Table of Content 目录表

IF 5.1 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2025-12-01 DOI: 10.1016/S1546-1440(25)00609-X

引用次数: 0

Prevalence of Cannabis Use Among People Who Smoke Cigarettes and Are Scheduled for Lung Cancer Screening 吸烟和计划进行肺癌筛查的人群中大麻使用的流行程度

IF 5.1 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2025-12-01 DOI: 10.1016/j.jacr.2025.09.017

Rachel L. Rosen PhD , Joanna M. Streck PhD , Lucy Finkelstein-Fox PhD , Efrén J. Flores MD , Elyse R. Park PhD, MPH , Jennifer S. Haas MD, MSc , Nancy A. Rigotti MD

Background

Cannabis use in the US is increasing in prevalence among older adults and people who smoke cigarettes. Little is known about rates of use among adults 50 to 80 years old undergoing lung cancer screening (LCS). The current study aimed to characterize the prevalence and correlates of cannabis use among adults 50 to 80 years old at high risk for lung cancer.

Methods

This secondary analysis of data collected in 2019 to 2023 from a randomized trial that tested a smoking cessation intervention integrated with LCS. The analysis included 638 patients who were scheduled for LCS and reported smoking cigarettes in the past 30 days. We characterized the prevalence of cannabis use and describe demographic and psychological correlates of cannabis use among adults at high risk for lung cancer who smoke cigarettes and were scheduled for a LCS test.

Results

Nineteen percent of the sample co-used cannabis at baseline, and cannabis use was associated with younger age (62.2 versus 64.3, P < .001), male gender (57.5% versus 41.3%, P = .001), lower likelihood of being White (79.2% versus 85.3, P = .004), and greater likelihood of depression symptoms (37.2% versus 23.0%, P = .002), based on bivariate analyses.

Conclusion

Findings suggest that cannabis use is prevalent among adults 50 to 80 years old who smoke cigarettes and are scheduled for LCS. LCS provides an opportunity for assessment of and intervention for cannabis and tobacco use.

在美国，大麻的使用在老年人和吸烟人群中越来越普遍。在接受肺癌筛查（LCS）的50至80岁的成年人中，人们对其使用率知之甚少。目前的研究旨在描述50至80岁肺癌高危人群中大麻使用的流行程度及其相关因素。方法对2019年至2023年收集的一项随机试验数据进行二次分析，该试验测试了戒烟干预与LCS相结合的方法。该分析包括638名计划进行LCS并在过去30天内报告吸烟的患者。我们描述了大麻使用的流行程度，并描述了吸烟并计划进行LCS测试的肺癌高危成年人中大麻使用的人口学和心理相关因素。结果根据双变量分析，19%的样本在基线时共同使用大麻，大麻使用与年龄较小（62.2%对64.3,P < 0.001）、男性（57.5%对41.3%,P = 0.001）、白人可能性较低（79.2%对85.3,P = 0.004）和抑郁症状可能性较大（37.2%对23.0%,P = 0.002）相关。结论研究结果表明，大麻使用在50至80岁吸烟并计划进行LCS的成年人中普遍存在。LCS为大麻和烟草使用情况的评估和干预提供了机会。

{"title":"Prevalence of Cannabis Use Among People Who Smoke Cigarettes and Are Scheduled for Lung Cancer Screening","authors":"Rachel L. Rosen PhD , Joanna M. Streck PhD , Lucy Finkelstein-Fox PhD , Efrén J. Flores MD , Elyse R. Park PhD, MPH , Jennifer S. Haas MD, MSc , Nancy A. Rigotti MD","doi":"10.1016/j.jacr.2025.09.017","DOIUrl":"10.1016/j.jacr.2025.09.017","url":null,"abstract":"<div><h3>Background</h3><div>Cannabis use in the US is increasing in prevalence among older adults and people who smoke cigarettes. Little is known about rates of use among adults 50 to 80 years old undergoing lung cancer screening (LCS). The current study aimed to characterize the prevalence and correlates of cannabis use among adults 50 to 80 years old at high risk for lung cancer.</div></div><div><h3>Methods</h3><div>This secondary analysis of data collected in 2019 to 2023 from a randomized trial that tested a smoking cessation intervention integrated with LCS. The analysis included 638 patients who were scheduled for LCS and reported smoking cigarettes in the past 30 days. We characterized the prevalence of cannabis use and describe demographic and psychological correlates of cannabis use among adults at high risk for lung cancer who smoke cigarettes and were scheduled for a LCS test.</div></div><div><h3>Results</h3><div>Nineteen percent of the sample co-used cannabis at baseline, and cannabis use was associated with younger age (62.2 versus 64.3, <em>P</em> < .001), male gender (57.5% versus 41.3%, <em>P</em> = .001), lower likelihood of being White (79.2% versus 85.3, <em>P</em> = .004), and greater likelihood of depression symptoms (37.2% versus 23.0%, <em>P</em> = .002), based on bivariate analyses.</div></div><div><h3>Conclusion</h3><div>Findings suggest that cannabis use is prevalent among adults 50 to 80 years old who smoke cigarettes and are scheduled for LCS. LCS provides an opportunity for assessment of and intervention for cannabis and tobacco use.</div></div>","PeriodicalId":49044,"journal":{"name":"Journal of the American College of Radiology","volume":"22 12","pages":"Pages 1618-1624"},"PeriodicalIF":5.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145625171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Sociodemographic and Health Care Factors Associated With Enrollment in a Randomized Clinical Trial Integrating Tobacco Cessation Into Lung Cancer Screening 在一项将戒烟纳入肺癌筛查的随机临床试验中，与入组相关的社会人口统计学和卫生保健因素

IF 5.1 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology

Pub Date : 2025-12-01 DOI: 10.1016/j.jacr.2025.07.016

Efrén J. Flores MD , Caylin Marotta MPH , Yuchiao Chang PhD , Bianca Porneala MS , Jaqueline Contrera Avila PhD , Terry Liu , Amy J. Wint MSc , Ruth C. Carlos MD, MS , Jordan M. Neil PhD , Irina Gonzalez MD , Sydney E. McGovern MS , Douglas E. Levy PhD, MPH , Jennifer S. Haas MD, MSPH , Nancy A. Rigotti MD , Elyse R. Park PhD, MPH

Purpose

This study evaluates the association of sociodemographic and health care factors with enrollment in a tobacco-cessation randomized controlled trial (Screen ASSIST) among individuals undergoing lung cancer screening (LCS).

Methods

This retrospective study used data gathered from the electronic health record and zip code-based area deprivation index (ADI) of individuals who were eligible for Screen ASSIST at 11 sites from April 2019 to July 2023. The primary outcome of interest was to assess the association between sociodemographic factors (including ADI) and health factors (including Charlson Comorbidity Index) and clinical trial enrollment. Univariate and logistic regression analyses were performed to assess the primary outcome of the study.

Results

In all, 4,090 individuals met eligibility criteria, and 642 (15.7%) were enrolled. Both enrolled and unenrolled groups had no significant difference in average age (enrolled individuals 63.2 ± 6.5 years; unenrolled individuals 63.0 ± 6.5 years), national (20.2 for enrolled versus 19.9 for not enrolled) and state (4.6 for enrolled versus 4.7 for not enrolled) ADI rankings, Charlson Comorbidity Index scores (1.3 for both), and other self-reported sociodemographic characteristics including being of predominantly White race, non-Hispanic ethnicity, having English listed as their preferred language, and having a high school degree or greater. Logistic regression analyses showed higher likelihood of enrollment was associated with age 70 years or older compared with younger than 60 years (adjusted OR [aOR]: 1.29, 95% confidence interval [CI]: 1.00-1.66); female gender compared with male (aOR: 1.26, 95% CI: 1.06-1.50); non-Hispanic Black compared with non-Hispanic White (aOR: 1.87, 95% CI: 1.37-2.54); college degree education compared with less than high school degree (aOR: 1.47, 95% CI: 1.03-2.12); and zero primary care physician visits over the past 12 months compared with three or more (aOR: 1.43, 95% CI: 1.16-1.76).

Conclusion

Several factors previously associated with lower enrollment rates had greater likelihood of enrollment in our LCS-integrated tobacco cessation trial. Offering clinical trial recruitment integrated into existing clinical pathways may represent an opportune window to promote equity in clinical trial participation and LCS uptake and improve tobacco-related health outcomes.

目的：本研究评估社会人口学和卫生保健因素与接受肺癌筛查（LCS）的个体参加戒烟随机对照试验（Screen ASSIST）的关系。方法本回顾性研究收集了2019年4月至2023年7月11个地点符合筛查协助条件的个人的电子健康记录和基于邮政编码的区域剥夺指数（ADI）数据。主要目的是评估社会人口学因素（包括ADI）和健康因素（包括Charlson共病指数）与临床试验入组之间的关系。采用单因素和逻辑回归分析来评估研究的主要结局。结果4090人符合入选标准，其中642人（15.7%）入选。入组与未入组的平均年龄无显著差异(入组个体63.2±6.5岁；未入组个体（63.0±6.5岁）、全国（入组20.2对未入组19.9）和州（入组4.6对未入组4.7）ADI排名、Charlson共病指数得分（两者均为1.3），以及其他自我报告的社会人口学特征，包括主要为白人、非西班牙裔、英语被列为首选语言、具有高中或更高学历。Logistic回归分析显示，与60岁以下患者相比，70岁及以上患者入组的可能性更高（调整or [aOR]: 1.29, 95%可信区间[CI]: 1.00-1.66）；女性与男性比较（aOR: 1.26, 95% CI: 1.06-1.50）；非西班牙裔黑人与非西班牙裔白人的比较（aOR: 1.87, 95% CI: 1.37-2.54）；大学学历与高中以下学历相比（aOR: 1.47, 95% CI: 1.03-2.12）；在过去的12个月里，与3次或更多的初级保健医生就诊相比，零次就诊（aOR: 1.43, 95% CI: 1.16-1.76）。结论：在我们的lcs综合戒烟试验中，先前与低入组率相关的几个因素更有可能入组。将临床试验招募整合到现有的临床途径中，可能是促进临床试验参与和LCS吸收公平以及改善烟草相关健康结果的一个合适窗口。

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