DISCOVER – the development and piloting of a radiographer-led smoking cessation intervention in the lung cancer screening setting

Background

Diagnostic Radiographers often see patients who smoke, and they could talk to these patients about quitting during their scan appointments.

Patients expect to have these conversations with healthcare professionals, and it can encourage them to seek help to quit. However, many radiographers do not feel confident about having these conversations and would like training to support them to do so.

This study, led by Dr Rebecca Beeken and Dr Nick Woznitza, explored some of the things that can make it more difficult for Diagnostic Radiographers to talk to their patients about quitting smoking, as well as some of the things that might help them have these conversations.

The team looked at previous research and interviewed 20 radiographers. This process revealed that a lack of knowledge, the organisational structure of the workplace, fears about patient reactions and personal views were making it more difficult for radiographers to have these conversations.

The research team developed a training course to try to address these concerns, and involved patients to make sure they too felt it was appropriate. The training was designed to support radiographers to have brief conversations about smoking cessation with patients.

At this point, 12 radiographers were asked to try out the training. They were interviewed remotely via telephone or online to provide an in-depth understanding of their experience of the intervention, including any identified problems with training, delivery, or perceived patient experience.

The group of radiographers indicated that the training was acceptable and reported improvements in their confidence and knowledge that would help them to have conversations with their patients about quitting smoking.

DISCOVER training … could support Diagnostic Radiographers to discuss smoking cessation with their patients

What is the problem to be addressed?

Diagnostic Radiographers are uniquely paced to provide smoking cessation advice to patients that they see, in line with a cross-government strategy called Making Every Contact Count. However, work to date had focused on supporting Therapeutic Radiographers to have these conversations, as they have longer-term contacts and relationships with patients.

Findings and outcomes

The research team completed a scoping review of the area that identified six studies exploring the provision of smoking cessation advice by radiographers, and which suggested radiographers could be a potential avenue for health promotion. However, there are several barriers in their working practice that need to be addressed.

Interviews with 20 Diagnostic Radiographers about their experiences of providing smoking cessation support to patients, and perceived barriers and facilitators, supported findings from the scoping review. These interviews also revealed other insights shared by radiographers around overstepping boundaries and confidence alongside potential facilitators.

Data from the scoping review and interviews were mapped onto models of behaviour change, and together with input from patients and Radiographers, informed the development of the DISCOVER online training materials.

The team piloted the DISCOVER training materials with 12 Diagnostic Radiographers, demonstrated its acceptability, and gained preliminary evidence for the training improving attitudes towards, and knowledge about, providing smoking cessation advice.

The team also explored the opportunity to collaborate with the Society of Radiographers to provide the training with the widest possible reach to Diagnostic Radiographers, and they were keen and supportive.

There were some changes to the original design of this project:

Originally, the aim was to develop and pilot a training package to specifically support delivery of smoking cessation by Diagnostic Radiographers in lung cancer screening settings. The team sought and obtained approval in August 2020 to widen the scope of the intervention based on preliminary findings suggesting there was a broader need from Diagnostic Radiographers.

In light of the impact of Covid-19, the research team also sought and obtained approval for the training to be developed for online delivery, to include a systematic review (scoping review due to limited relevant research), and to pilot the training just with radiographers (not collecting patient data).

Benefits of the project

Providing this training to Diagnostic Radiographers could support increases in the provision of very brief advice to patients and direct them to smoking cessation services, which could ultimately reduce deaths from lung cancer and improve treatment outcomes for those with an early diagnosis.

Diagnostic Radiographers working in lung cancer screening settings could also benefit from this training, which may improve patient experience of screening, encouraging uptake and promoting early detection due to higher patient satisfaction.

Publications

None to date, but drafts of the scoping review, and training development are in progress.

Is this RCLCF funded work (or aspects of it) being continued with new funding?

While the team will not be taking additional steps to continue evaluating the training that has been developed, they are exploring opportunities with the Society of Radiographers to adopt this training into their ‘Clinical Imaging’ e-learning portfolio on the eLearning for Healthcare website.

Have any important collaborations resulted from this RFCLCF-funded project?

As above, the team is exploring opportunities with the Society of Radiographers to adopt this training into their ‘Clinical Imaging’ e-learning portfolio on the eLearning for Healthcare website.

Has this research resulted in changes to healthcare policy, education or training?

Not as yet, but if adopted by the Society of Radiographers, it may lead to changes in practice, and could help save more lives from lung cancer and other smoking-related diseases.

About the grant holders

Dr Rebecca Beeken is a Fellow of the Higher Education Academy (2018). She was a member of CRUK’s Expert Review Panel for the Prevention and Population Research Committee (2022) and a Review & Interview Panel member for the Irish Cancer Society, Social Sciences, Nursing, and Allied Health Research Scholarship (2022). She is the Co-Chair for the UK Society for Behavioural Medicine Cancer Prevention and Management Special Interest Group, Deputy Chair for the International Society of Behavioural Nutrition and Physical Activity Special Interest Group – Cancer Prevention and Management, and a member of the NIHR Nutrition & Cancer Collaboration.

Dr Nick Woznitza is a Fellow of the British Institute of Radiology (2018) and a Fellow of the College of Radiographers (2021). He was awarded an MBE in the Queen’s New Year’s honours list in 2022 for services to radiography and as part of the COVID-19 response. He is the co-Chair of the Artificial Intelligence in Radiography Working Group, Clinical Director of the Radiographer Reporting Programme (Health Education England) and Associate Editor for the Journal of Medical Radiation Sciences.

In addition, William Goodman is an Associate Editor for the journal ‘Pilot and Feasibility Studies’.

What is the grant holder/researcher doing now?

Dr Beeken is an Associate Professor of Behavioural Medicine at the University of Leeds, and continues to lead and collaborate on research to support behaviour change for cancer prevention and control.

Dr Nick Woznitza is a Consultant Radiographer & Clinical Academic at University College London Hospitals NHS Foundation Trust & Canterbury Christ Church University

Laura Brown (original researcher employed on the project) is working as Dietitian within the NHS.

William Goodman (subsequent researcher employed on the project) is in the final year of his PhD at the University of Leeds, exploring quality of life and self-management in people with a stoma. He is currently exploring international collaborations with teams in the field of exercise oncology.

How important has this funding been to the researcher?

This funding enabled Dr Beeken and Dr Woznitza to work together for the first time, and gain a better understanding of their respective disciplines (behavioural science and clinical imaging). For Dr Beeken this project was her first funded project in the area of smoking cessation, and she has subsequently become involved in larger projects in this area such as the Yorkshire Enhanced Smoking Cessation Study led by Professor Rachael Murray.

The Roy Castle project also provided experience of supporting behaviour change in healthcare professionals, as opposed to patients, and she is involved in other grant applications in this area that may support her to continue work in this space more broadly to improve patient outcomes.