Lung cancer screening (LCS) is now recommended for people at high risk of dying from lung cancer. The purpose of this study is to use the LCS decision discussion as a case study to understand possible underlying components of a teachable moment to enhance motivation for smoking cessation.We investigated how patients and clinicians communicate about smoking by performing in-depth, semi-structured interviews of the experiences of 51 individuals who formerly or currently smoked offered LCS, and 24 clinicians. We discuss the baseline interviews only since including the follow-up interviews would be beyond the scope of this manuscript. Interviews focused on communication about smoking, the perceived importance of discussing smoking and screening together, and patients' perceived challenges to smoking cessation.Patients and clinicians differed in their views on the role of the LCS decision discussion as a teachable moment. While clinicians felt that this discussion was a good opportunity to positively influence smoking behaviors, neither patients nor clinicians perceived the discussion as a teachable moment impacting smoking behaviors. We found there are other motivating factors for smoking cessation.Our findings indicate that LCS decision discussions are not a teachable moment for behavior change in smoking cessation now, but perhaps clinicians could address other aspects of communication to enhance motivation for cessation. Our hypothesized teachable moment model helps explain there may not be sufficient emotional response elicited during the discussion to motivate a major behavior change like smoking cessation.