Career Development Award: Center for Appalachian Research in Environmental Sciences: Dr. Stanifer's UKCARES Career Development

S. Stanifer, PhD, APRN, AOCNS Career Development Award Abstract Lung cancer is the leading cause of cancer mortality, yet the environmentally induced disease remains highly preventable. Cigarette smoking is the leading cause of lung cancer, followed by exposure to radon. Co-exposure to tobacco and radon has a synergistic effect on the development of lung cancer, putting those exposed to both at a 10-fold greater risk. Primary care providers (PCP) are well-positioned to influence a patient’s environmental risk reduction and cancer screening behaviors. In 2013, the U.S. Preventive Services Task Force first issued its recommendation for annual lung cancer screening using low- dose CT. Today, lung cancer screening is recommended for high-risk individuals aged 50 to 80 who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening for lung cancer can reduce mortality, yet only 13% of high-risk Kentuckians have been screened. Because screening for lung cancer does not come without risk, the Centers for Medicare and Medicaid Services (CMS), as well as most insurance companies, require patients have a shared decision making (SDM) visit prior to referral for screening, including the use of one or more decision aids. Shared decision-making is a patient centered approach guided by the premise that when patients participate in making decisions about their care, guided by their personal values and opinions, when armed with good information, clinicians will respect patients values and opinions and use them to guide recommendations for their medical care. Decision aids are often used to guide conversations and help clinicians assist patients in making decisions about their care. In lung cancer screening SDM, decision aids provide the patient with information on eligibility criteria and benefits and harms of screening. In addition, clinical practice guidelines recommend SDM and decision aids address tobacco cessation. There is no mention of radon testing or mitigation in these practice guidelines. The integration of tobacco and radon risk reduction messaging in public health has received little attention despite being recommended by the World Health Organization. This major gap in primary prevention is concerning. The scientific premise is that the lung cancer screening SDM visit in which providers offer high-risk individuals smoking cessation treatment is an ideal teachable moment to offer patient-centered care which raises awareness of tobacco and radon synergism and promote home radon testing and mitigation. I intend to (1) explore patient and provider attitudes, perceptions and preferences related to lung cancer screening and synergistic risk messaging and (2) develop and evaluate a theory-based lung cancer screening shared decision-making aid which incorporates tobacco and radon synergistic risk messaging. The aim of the training and research outlined in this proposal is to gather greater knowledge and experience in shared decision making, risk communication, and implementation science that will inform this and future projects which seek to include tobacco and radon risk reduction messaging in clinical care.