Patients’ Views on Medical Events in Lung Cancer Screening as Teachable Moments for Smoking Behaviour Change: A Systematic Review and Metasynthesis

Table 3

Brief characteristics of the analysed papers.

Study	Aim(s)	Setting	Sample characteristics	Outcomes measured	Study design	Main findings
Golden et al. [20]	To evaluate the experiences of patients who formerly or currently smoke who underwent LCS decision-making discussions.	USA	33 patients who currently smoke and 18 patients who formerly smoke.; LDCT results were not recorded.	Patients’ views on patient-clinician interactions.	Qualitative 1 : 1 semistructured interviews.	(1) LCS decision-making discussions rarely influenced smoking behaviour change.; (ii) Increased reframing elicits negative emotional responses, making discussions an effective TM.
Kathuria et al. [21]	To understand patients’ views on communication about LCS and smoking cessation, integration of smoking cessation discussions within LCS, and if LCS discussions are a TM for smoking cessation.	USA	28 patients who currently smoke and 21 patients who formerly smoke.; LDCT results were not recorded.	Patients’ views on patient-clinician interactions.	Qualitative 1 : 1 semistructured interviews and focus groups.	(i) LCS was a TM for smoking cessation because LCS prompted awareness of the harms of smoking and evoked vulnerability, relief, and worry.; (ii) Patients had varied experiences of LCS discussions because they viewed the purpose of LCS differently from one another.
Kummer et al. [22]	To explore positive and negative psychological and behavioural responses among individuals with indeterminate (i.e., unclear) and incidental (i.e., discovered by chance) LDCT screening results.	USA	18 patients who currently smoke and 10 patients who formerly smoke.; LDCT results: indeterminate (), incidental (), and negative ().	Patients’ views on LCS pathway (i.e., referral, communication, and result).	Qualitative 1 : 1 semistructured interviews.	(i) The LDCT result, concerns and health expectations, negative beliefs, and perceived stigma influenced individual differences in psychological and behavioural responses.; (ii) Patients with incidental results cut down on smoking when compared to patients with indeterminate results.
Meltzer et al. [23]	To develop and examine the feasibility and acceptability of a self-help smoking cessation intervention when patients who smoke viewed low-dose computed tomography (LDCT) to be a teachable moment.	USA	31 patients who currently smoke LDCT results: positive () and negative ().	Patients’ views on LCS with LDCT and smoking cessation via focus groups.	Focus groups () and learner verification interviews () using semistructured interview guides.	(i) Focus group participants wished the process of receiving LDCT addressed counterproductive thoughts about negative LCS results.; (ii) They wanted to enjoy a healthy and smoke-free retirement, increase self-efficacy about smoking cessation, and see survival statistics after quitting.; (iii) Learner verification participants favoured most booklet and pamphlet changes.; (iv) Feasibility findings showed high acceptability and satisfaction of the LDCT self-help cessation intervention.
Mishra et al. [24]	To determine patients’ knowledge and attitudes about LDCT, LCS, smoking cessation, and decision-making for LCS.	USA	Nine patients who currently smoke and 13 patients who formerly smoke. LDCT results: positive () and negative ().	Patients’ views on LCS with LDCT and smoking cessation.	Qualitative 1 : 1 semistructured interviews.	(i) Many patients were unaware of LDCT but were open to engaging in LCS.; (ii) Some contemplated quitting if they received positive results.; (iii) Patients preferred 1 : 1 discussion with clinicians during LCS to support decision-making.
Rowland et al. [26]	To explore the health-related quality of life (HRQoL) and support experiences among newly diagnosed patients with advanced lung cancer.	UK	Three patients who currently smoke and six patients who formerly smoke.; All participants had a positive diagnosis of lung cancer.	Patients’ views on LCS and smoking cessation.	Qualitative 1 : 1 semistructured interviews.	(i) Patients feared compromising their immune systems and adjusting to new relationships which impacted their HRQoL.; (ii) Patients knew about the links between lung cancer and smoking but continued smoking.; (iii) Those who recently quit or continued smoking were sensitive to the opinions of medical staff about smoking.
Park et al. [25]	To explore if LCS or risk perceptions act as a cue for smoking behaviour change and identify postscreening behavioural intentions and changes.	USA	17 patients who currently smoke and 18 patients who formerly smoke.; LDCT results: true positive (), false positive (), and negative ().	Patients’ views on smoking behaviour following LCS.	Qualitative 1 : 1 semistructured interviews.	(i) High-risk perceptions and low confidence in quitting did not translate to cessation after LCS.; (ii) Cognitive, emotional dissonance, and avoidance strategies deterred smoking behaviour change.
Simmons et al. [27]	To fill a gap in research by examining cancer patient-provider communication regarding tobacco use and patients’ perspectives regarding their experiences with smoking cessation and relapse.	USA	10 patients who currently smoke and 10 patients who formerly smoke.; All participants had a positive diagnosis of lung cancer.	Patients’ views on LCS and smoking cessation.	Qualitative telephone-based 1 : 1 semistructured interviews.	(i) They had high motivation to quit smoking but did not ask for assistance to quit and maintain abstinence.; (ii) Patients who relapsed were reluctant to disclose smoking behaviour due to stigma and guilt.; (iii) Patients believed clinicians gave different information, advice, and assistance.; (iv) Clinicians asserted the long-term risks of smoking and briefly recommended cessation interventions.
Wells et al. [28]	To explore the experiences and views of patients, family members, and healthcare professionals towards smoking and smoking cessation around the time of cancer diagnosis.	UK	15 patients who currently smoke and 14 patients who formerly smoke.; All participants had a positive diagnosis of lung cancer.	Patients’ views on LCS and smoking cessation.	Qualitative 1 : 1 semistructured interviews.	(i) Few had meaningful discussions with professionals about smoking.; (ii) Some continued to smoke because of the stress after diagnosis and did not understand the link between smoking, cancer, and health.
Young et al. [29]	To understand how lung cancer screening influences individual motivations about smoking, including in those who have stopped smoking since the screening.	UK	20 patients who currently smoke and 11 patients who formerly smoke. Early LDCT results: positive () and negative ().	Patients’ views on LCS with LDCT and smoking cessation.	Qualitative 1 : 1 semistructured interviews.	(i) Interpretation of results led to emotional responses causing smoking behaviour change.; (ii) LCS and family support were a “wake-up call” for cessation.; (iii) No clear pattern in smoking motivations based on LCS results.; (iv) Some underwent screening to try to stop smoking, while others had minimal or no desire to stop.
Zeliadt et al. [30]	To understand views on smoking cessation from patients who formerly or currently smoke when offered LCS.	USA	34 patients who currently smoke and three patients who formerly smoke. LDCT results were not recorded.	Patients’ views on LCS within routine care and smoking cessation.	Qualitative telephone-based 1 : 1 semistructured interviews.	(i) LCS prompted patients who currently smoke to reflect on their health which provides an opportunity for patients to engage in cessation discussions.; (ii) Discussions should focus on emotional responses to LCS rather than clinical details.

Note: LCS = lung cancer screening; LDCT = low-dose computed tomography; TM = teachable moment; HRQoL = health-related quality of life.