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CDA 11-256 – HSR&D Study

 
CDA 11-256
A Targeted Risk Communication Tool for Tobacco-Dependent Veterans with Cancer
Paul Krebs PhD
VA San Diego Healthcare System, San Diego, CA
San Diego, CA
Funding Period: July 2013 - June 2018

BACKGROUND/RATIONALE:
Continuing to smoke after cancer diagnosis has serious negative consequences for patients including reduced treatment effectiveness, decreased survival, and greater risk of cancer returning. A large portion of cancer patients, however, continue to smoke and among those who quit, 40-50% relapse usually within a few months. Tobacco cessation has not been provided in the outpatient cancer care setting, despite findings that tobacco interventions are most effective within 3 months of diagnosis.

OBJECTIVE(S):
Few studies have examined tobacco cessation among cancer patients. Of these, only one study found an intervention effect, with low quit rates (14-30%) across studies. This and other research suggests that most cancer patients do not understand the risk of continued smoking on their prognosis and treatment outcomes. No studies have explored whether more clearly communicating the risks and consequences of tobacco use to patients improves quit rates over current cessation treatment. Therefore, this study is working to achieve two main objectives: 1) Develop a risk communication tool to enhance clinical cessation interventions and educate cancer patients about risks associated with continued tobacco use and 2) Conduct a randomized pilot study (best practices vs. best practices + targeted risk communication) among tobacco-dependent Veterans receiving outpatient cancer care. Primary outcomes will be use of quitline services and tobacco cessation.

METHODS:
The research is being conducted in two phases. During the first developmental phase, we developed a risk communication tool and refined it using cognitive interviews with patients. In the second phase we are conducting a RCT of the risk communication tool. Oncology nurses will provide N=50 VA cancer patients with best-practices cessation treatment (advice, medications, and referral to the state Quitline) alone or in addition to reviewing the decision aid with patients. Patient reactions and quitting outcomes will be surveyed at 2-weeks post-encounter and at 6-months. We will evaluate motivation to quit, 7-day abstinence, and moderators of cessation, as well as gather data related to costs.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
The goal of this project has been to create a feasible, acceptable, and effective tool for helping providers educate Veterans with cancer about the consequences of continued smoking.

We will begin analyzing the data in the coming months, so research and practice implications are pending. However, I have worked with oncology leadership at New York, training 6 oncology fellows and 4 nurses in brief tobacco interventions in the oncology setting.

The project has also been an excellent training opportunity for interns, and throughout the course of the project 4 interns have assisted with the project learning about research design, survey methods, data record keeping, and cost analysis.

Materials from the project evalhave been integrated into Dr. Krebs' CDC study and in a VA pilot and subsequent IIR on which Dr. Krebs is a co-I with Dr. Steve Zeliadt (PI) regarding communicating risk information about smoking to Veterans receiving lung cancer screening.


External Links for this Project

NIH Reporter

Grant Number: IK2HX000850-01A2
Link: https://reporter.nih.gov/project-details/8485162

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PUBLICATIONS:

None at this time.


DRA: Cancer
DRE: Technology Development and Assessment
Keywords: none
MeSH Terms: none

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