Phone Enabled Implementation of Cessation Support (PHOENICS)

项目摘要 本提案的目的是评价有前途的多组分 在黎巴嫩国家安全网系统中实施循证烟草治疗的干预措施 初级保健中心，为50%以上的人口提供服务。这一目标直接 响应NCI特别关注通知（NOT-CA-20 - 025）： 低资源环境下的癌症预防和控制。黎巴嫩的烟草使用负担是 异常高：35%的成年人是目前的吸烟者，39%是水烟筒吸烟者，5%是双重吸烟者。 吸烟者。世卫组织认可三种干预措施作为人口水平烟草的实践标准 依赖治疗：将戒烟建议纳入初级保健环境;易于获得 电话咨询;低成本尼古丁替代疗法（NRT）。然而，这些证据 干预措施主要来自高收入国家，很少在低收入国家和 中等收入国家（LMIC）。此外，建议的干预措施没有作为常规部分纳入 在黎巴嫩的初级保健中，与其他资源匮乏的环境一样。解决这一从证据到实践问题 gap要求研究多层次的干预措施和背景因素，以实施综合的，可扩展的， 以及在资源匮乏的环境中进行可持续的戒烟治疗。我们将进行一项分组随机试验 比较三组：1）询问烟草使用情况，建议戒烟，协助简短咨询（AAA）作为标准 护理; 2）询问，建议，连接到基于电话的咨询（AAC）;和3）AAC + NRT。我们的核心假设是 将患者与NRT的电话咨询联系起来是最有效的选择。我们的混合 设计遵循勘探、准备、实施和维持（EPIS）框架， 强调关键步骤和多层次因素，以优化实施的成功。我们将继续努力 具体目标：1）调整和定制现有的戒烟计划，以提供基于电话的咨询， 黎巴嫩的吸烟者; 2）测试一个以烟草为基础的计划的有效性和成本效益， 为初级保健患者提供戒烟服务;以及3）确定 使用混合方法的执行和可持续性。该项目的目的是提供证据， 在资源匮乏的环境中提供烟草依赖治疗的实践差距， 测试因地制宜的多层面干预措施，优化实施的成功和可持续性。 这项研究具有重要意义，因为它有可能指导大规模采用具有成本效益的战略， 在低资源环境中实施烟草依赖治疗，从而减少与烟草有关的 发病率和死亡率。

PROJECT SUMMARY The objective of this proposal is to evaluate the comparative effectiveness of promising multi-component interventions for implementing evidence-based tobacco treatment in Lebanon’s national system of safety net primary healthcare centers, which serves more than 50% of the population. This objective is directly responsive to NCI Notice of Special Interest (NOT-CA-20-025): Dissemination and Implementation Science for Cancer Prevention and Control in Low Resource Environments. The tobacco use burden in Lebanon is exceptionally high: 35% of adults are current cigarette smokers, 39% are waterpipe smokers, and 5% are dual smokers. The WHO endorses three interventions as the standard of practice for population-level tobacco dependence treatment: smoking cessation advice integrated into primary care settings; easily-accessible phone-based counseling; and low-cost nicotine replacement therapy (NRT). However, the evidence for these interventions comes primarily from high-income countries and they have rarely been evaluated in low- and middle-income countries (LMICs). Further, recommended interventions are not integrated as a routine part of primary care in Lebanon, as is the case in other low-resource settings. Addressing this evidence-to-practice gap requires research on multilevel interventions and contextual factors for implementing integrated, scalable, and sustainable cessation treatment within low-resource settings. We will conduct a group-randomized trial comparing three arms: 1) Ask about tobacco use, advise to quit, assist with brief counseling (AAA) as standard care; 2) Ask, advise, connect to phone-based counseling (AAC); and 3) AAC+NRT. Our central hypothesis is that connecting patients to phone-based counseling with NRT is the most effective alternative. Our hybrid design is informed by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework which emphasizes key steps and multilevel factors to optimize implementation success. We will pursue the following specific aims: 1) adapt and tailor an existing smoking cessation program to deliver phone-based counseling to smokers in Lebanon; 2) test the effectiveness and cost-effectiveness of a referral-based program that delivers smoking cessation services to primary care patients; and 3) identify the multilevel determinants of implementation and sustainability using mixed methods. The proposed project addresses the evidence-to- practice gap in the provision of tobacco dependence treatment within low-resource settings by developing and testing contextually-tailored multilevel interventions and optimizing implementation success and sustainability. This research is significant for its potential to guide the large-scale adoption of cost-effective strategies for implementing tobacco dependence treatment in low-resource settings thereby reducing tobacco-related morbidity and mortality.