The Chest Australia Trial: A randomised controlled trial of an intervention to increase consultation rates in smokers at risk of lung cancer

Jon D. Emery, Sonya R. Murray, Fiona M. Walter, Andrew Martin, Stephen Goodall, Danielle Mazza, Emily Habgood, Yvonne Kutzer, David John Barnes, Peter Murchie

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: International research has focused on screening and mass media campaigns to promote earlier patient presentation and detect lung cancer earlier. This trial tested the effect of a behavioural intervention in people at increased risk of lung cancer on help-seeking for respiratory symptoms. Methods: Parallel, individually randomised controlled trial. Eligible participants were long-term smokers with at least 20 pack-years, aged 55 and above. The CHEST intervention entailed a consultation to discuss and implement a self-help manual, followed by self-monitoring reminders to encourage help-seeking for respiratory symptoms. The control group received a brief discussion about lung health. Both groups had baseline spirometry. Telephone randomisation was conducted, 1:1, stratified Medical Research Council (MRC) dyspnoea score and general practice. Participants could not be blinded; data extraction and statistical analyses were performed blinded to group assignment. The primary outcome was respiratory consultation rates. Results: We randomised 551 participants (274 intervention, 277 control) from whom the primary outcome was determined for 542 (269 intervention, 273 control). There was a 40% relative increase in respiratory consultations in the intervention group: (adjusted rates (95% CI) intervention 0.57 (0.47 to 0.70), control 0.41 (0.32 to 0.52), relative rate 1.40 (1.08 to 1.82); p=0.0123). There were no significant differences in time to first respiratory consultation, total consultation rates or measures of psychological harm. The incremental cost-effectiveness ratio was $A1289 per additional respiratory consultation. Conclusions: A behavioural intervention can significantly increase consulting for respiratory symptoms in patients at increased risk of lung cancer. This intervention could have an important role in primary care as part of a broader approach to improve respiratory health in patients at higher risk.

Original languageEnglish
Pages (from-to)362-370
Number of pages9
JournalThorax
Volume74
Issue number4
DOIs
Publication statusPublished - 1 Apr 2019

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Lung Neoplasms
Thorax
Referral and Consultation
Randomized Controlled Trials
Mass Media
Statistical Data Interpretation
Spirometry
Health
Respiratory Rate
Random Allocation
Telephone
General Practice
Dyspnea
Cost-Benefit Analysis
Biomedical Research
Primary Health Care
Psychology
Lung
Control Groups
Research

Cite this

Emery, Jon D. ; Murray, Sonya R. ; Walter, Fiona M. ; Martin, Andrew ; Goodall, Stephen ; Mazza, Danielle ; Habgood, Emily ; Kutzer, Yvonne ; Barnes, David John ; Murchie, Peter. / The Chest Australia Trial : A randomised controlled trial of an intervention to increase consultation rates in smokers at risk of lung cancer. In: Thorax. 2019 ; Vol. 74, No. 4. pp. 362-370.
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title = "The Chest Australia Trial: A randomised controlled trial of an intervention to increase consultation rates in smokers at risk of lung cancer",
abstract = "Background: International research has focused on screening and mass media campaigns to promote earlier patient presentation and detect lung cancer earlier. This trial tested the effect of a behavioural intervention in people at increased risk of lung cancer on help-seeking for respiratory symptoms. Methods: Parallel, individually randomised controlled trial. Eligible participants were long-term smokers with at least 20 pack-years, aged 55 and above. The CHEST intervention entailed a consultation to discuss and implement a self-help manual, followed by self-monitoring reminders to encourage help-seeking for respiratory symptoms. The control group received a brief discussion about lung health. Both groups had baseline spirometry. Telephone randomisation was conducted, 1:1, stratified Medical Research Council (MRC) dyspnoea score and general practice. Participants could not be blinded; data extraction and statistical analyses were performed blinded to group assignment. The primary outcome was respiratory consultation rates. Results: We randomised 551 participants (274 intervention, 277 control) from whom the primary outcome was determined for 542 (269 intervention, 273 control). There was a 40{\%} relative increase in respiratory consultations in the intervention group: (adjusted rates (95{\%} CI) intervention 0.57 (0.47 to 0.70), control 0.41 (0.32 to 0.52), relative rate 1.40 (1.08 to 1.82); p=0.0123). There were no significant differences in time to first respiratory consultation, total consultation rates or measures of psychological harm. The incremental cost-effectiveness ratio was $A1289 per additional respiratory consultation. Conclusions: A behavioural intervention can significantly increase consulting for respiratory symptoms in patients at increased risk of lung cancer. This intervention could have an important role in primary care as part of a broader approach to improve respiratory health in patients at higher risk.",
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Emery, JD, Murray, SR, Walter, FM, Martin, A, Goodall, S, Mazza, D, Habgood, E, Kutzer, Y, Barnes, DJ & Murchie, P 2019, 'The Chest Australia Trial: A randomised controlled trial of an intervention to increase consultation rates in smokers at risk of lung cancer' Thorax, vol. 74, no. 4, pp. 362-370. https://doi.org/10.1136/thoraxjnl-2018-212506

The Chest Australia Trial : A randomised controlled trial of an intervention to increase consultation rates in smokers at risk of lung cancer. / Emery, Jon D.; Murray, Sonya R.; Walter, Fiona M.; Martin, Andrew; Goodall, Stephen; Mazza, Danielle; Habgood, Emily; Kutzer, Yvonne; Barnes, David John; Murchie, Peter.

In: Thorax, Vol. 74, No. 4, 01.04.2019, p. 362-370.

Research output: Contribution to journalArticle

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T1 - The Chest Australia Trial

T2 - A randomised controlled trial of an intervention to increase consultation rates in smokers at risk of lung cancer

AU - Emery, Jon D.

AU - Murray, Sonya R.

AU - Walter, Fiona M.

AU - Martin, Andrew

AU - Goodall, Stephen

AU - Mazza, Danielle

AU - Habgood, Emily

AU - Kutzer, Yvonne

AU - Barnes, David John

AU - Murchie, Peter

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Background: International research has focused on screening and mass media campaigns to promote earlier patient presentation and detect lung cancer earlier. This trial tested the effect of a behavioural intervention in people at increased risk of lung cancer on help-seeking for respiratory symptoms. Methods: Parallel, individually randomised controlled trial. Eligible participants were long-term smokers with at least 20 pack-years, aged 55 and above. The CHEST intervention entailed a consultation to discuss and implement a self-help manual, followed by self-monitoring reminders to encourage help-seeking for respiratory symptoms. The control group received a brief discussion about lung health. Both groups had baseline spirometry. Telephone randomisation was conducted, 1:1, stratified Medical Research Council (MRC) dyspnoea score and general practice. Participants could not be blinded; data extraction and statistical analyses were performed blinded to group assignment. The primary outcome was respiratory consultation rates. Results: We randomised 551 participants (274 intervention, 277 control) from whom the primary outcome was determined for 542 (269 intervention, 273 control). There was a 40% relative increase in respiratory consultations in the intervention group: (adjusted rates (95% CI) intervention 0.57 (0.47 to 0.70), control 0.41 (0.32 to 0.52), relative rate 1.40 (1.08 to 1.82); p=0.0123). There were no significant differences in time to first respiratory consultation, total consultation rates or measures of psychological harm. The incremental cost-effectiveness ratio was $A1289 per additional respiratory consultation. Conclusions: A behavioural intervention can significantly increase consulting for respiratory symptoms in patients at increased risk of lung cancer. This intervention could have an important role in primary care as part of a broader approach to improve respiratory health in patients at higher risk.

AB - Background: International research has focused on screening and mass media campaigns to promote earlier patient presentation and detect lung cancer earlier. This trial tested the effect of a behavioural intervention in people at increased risk of lung cancer on help-seeking for respiratory symptoms. Methods: Parallel, individually randomised controlled trial. Eligible participants were long-term smokers with at least 20 pack-years, aged 55 and above. The CHEST intervention entailed a consultation to discuss and implement a self-help manual, followed by self-monitoring reminders to encourage help-seeking for respiratory symptoms. The control group received a brief discussion about lung health. Both groups had baseline spirometry. Telephone randomisation was conducted, 1:1, stratified Medical Research Council (MRC) dyspnoea score and general practice. Participants could not be blinded; data extraction and statistical analyses were performed blinded to group assignment. The primary outcome was respiratory consultation rates. Results: We randomised 551 participants (274 intervention, 277 control) from whom the primary outcome was determined for 542 (269 intervention, 273 control). There was a 40% relative increase in respiratory consultations in the intervention group: (adjusted rates (95% CI) intervention 0.57 (0.47 to 0.70), control 0.41 (0.32 to 0.52), relative rate 1.40 (1.08 to 1.82); p=0.0123). There were no significant differences in time to first respiratory consultation, total consultation rates or measures of psychological harm. The incremental cost-effectiveness ratio was $A1289 per additional respiratory consultation. Conclusions: A behavioural intervention can significantly increase consulting for respiratory symptoms in patients at increased risk of lung cancer. This intervention could have an important role in primary care as part of a broader approach to improve respiratory health in patients at higher risk.

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