The Chest Australia Trial

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

Jon Emery (Corresponding Author), Sonya R. Murray, Fiona M. Walter, Andrew Martin, Stephen Goodall, Danielle Mazza, Emily Habgood, Yvonne Kutzer, David J. Barnes, Peter Murchie

Research output: Contribution to journalArticle

2 Citations (Scopus)
4 Downloads (Pure)

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.

Trial registration number Australian New Zealand Clinical Trial Registry (1261300039 3752). This was registered pre-results.
Original languageEnglish
Pages (from-to)362-370
Number of pages9
JournalThorax
Volume74
Issue number4
Early online date14 Mar 2019
DOIs
Publication statusPublished - Apr 2019

Fingerprint

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

Keywords

  • lung cancer
  • DIAGNOSIS
  • PERFORMANCE
  • GENERAL-PRACTITIONER
  • PATIENT
  • SYMPTOMS
  • TIME
  • MODEL
  • SCALE
  • CARE

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

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

In: Thorax, Vol. 74, No. 4, 04.2019, p. 362-370.

Research output: Contribution to journalArticle

Emery, J, 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
Emery, Jon ; Murray, Sonya R. ; Walter, Fiona M. ; Martin, Andrew ; Goodall, Stephen ; Mazza, Danielle ; Habgood, Emily ; Kutzer, Yvonne ; Barnes, David J. ; 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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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.Trial registration number Australian New Zealand Clinical Trial Registry (1261300039 3752). This was registered pre-results.",
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author = "Jon Emery and Murray, {Sonya R.} and Walter, {Fiona M.} and Andrew Martin and Stephen Goodall and Danielle Mazza and Emily Habgood and Yvonne Kutzer and Barnes, {David J.} and Peter Murchie",
note = "Funding This trial was funded by the National Health and Medical Research Council (NHMRC grant ID 1064121). It was supported by the Cancer Australia Primary Care Collaborative Cancer Clinical Trials Group (PC4). JDE is supported by an NHMRC Practitioner Fellowship. FMW was supported by a Clinician Scientist award (RG 68235) from the National Institute for Health Research (NIHR). Acknowledgements We thank all the trial participants and general practices who were involved in this trial.",
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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

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 J.

AU - Murchie, Peter

N1 - Funding This trial was funded by the National Health and Medical Research Council (NHMRC grant ID 1064121). It was supported by the Cancer Australia Primary Care Collaborative Cancer Clinical Trials Group (PC4). JDE is supported by an NHMRC Practitioner Fellowship. FMW was supported by a Clinician Scientist award (RG 68235) from the National Institute for Health Research (NIHR). Acknowledgements We thank all the trial participants and general practices who were involved in this trial.

PY - 2019/4

Y1 - 2019/4

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.Trial registration number Australian New Zealand Clinical Trial Registry (1261300039 3752). This was registered pre-results.

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.Trial registration number Australian New Zealand Clinical Trial Registry (1261300039 3752). This was registered pre-results.

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KW - DIAGNOSIS

KW - PERFORMANCE

KW - GENERAL-PRACTITIONER

KW - PATIENT

KW - SYMPTOMS

KW - TIME

KW - MODEL

KW - SCALE

KW - CARE

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