A Targeted Risk Communication Tool for Tobacco-Dependent Veterans with Cancer

描述(由申请人提供)： 背景：癌症诊断后继续吸烟有严重的影响，导致治疗效果受损，生存率降低，复发风险增加，日常功能受损。尽管有这些风险，大约30%-50%的癌症患者继续吸烟，40%-50%的癌症吸烟者通常在几个月内复发。由于人口老龄化，被诊断为癌症的退伍军人人数每年都在增加。为了优化癌症治疗的有效性和生活质量，需要加大力度，在癌症护理中促进戒烟。理由：虽然许多人可能会认为在癌症诊断后戒烟是一个显而易见的决定，但针对癌症患者的有效戒烟干预仍然难以实现。很少有研究研究癌症患者的戒烟情况。在这些研究中，只有一项研究发现了干预效果，整个研究的戒烟率很低(14%-30%)。这项研究和其他研究表明，大多数癌症患者不知道继续吸烟对他们的预后和治疗结果的风险。虽然风险认知在行为改变中的作用得到了理论的有力支持，但还没有研究探索更清楚地向患者传达烟草使用的风险和后果是否会比目前的戒烟治疗提高戒烟率。因此，这项研究将创建一种沟通工具，帮助患者理解持续吸烟的含义，并帮助艾滋病提供者进行这些讨论，以增加患者的动力并促进长期戒烟。具体目标：目标1.开发有针对性的风险沟通工具，以加强临床戒烟干预，并教育癌症患者与持续使用烟草有关的风险。我们将使用患者认知访谈来收集患者对草案交流工具的反馈。目的2.在接受门诊癌症护理的烟草依赖退伍军人中进行一项随机试点研究(最佳实践与最佳实践+有针对性的风险沟通)。这项先导性研究(N=118)将a)提供关于资深癌症患者的戒烟动机、戒烟结果和患者可接受性的初步数据，并测试有针对性的风险沟通将增加戒烟动机的假设，以及b)评估与每一种干预措施相关的成本。方法：研究分两个阶段进行。在第一个开发阶段，我们将与健康沟通专家合作起草风险沟通工具，并通过对患者的认知访谈进一步完善它。在第二阶段，我们将进行一项随机试点项目，以评估风险沟通工具改善戒烟结果的潜力。在18个月的时间里，肿瘤科护士将为N=118名VA癌症患者提供最佳实践戒烟治疗(建议、药物和转介到州Quitline)，或者除了审阅一份信息表，其中有简单的语言解释和与吸烟和癌症相关的特定诊断风险数据的可视化表示。患者的反应和戒烟结果将在遭遇后2周和6个月时进行调查。我们将评估戒烟动机、7天禁欲和戒烟主持人，并收集与成本相关的数据。这一创新项目对改进以理论为基础的戒烟计划的设计和退伍军人管理局内癌症护理的质量具有重要意义。

DESCRIPTION (provided by applicant): Background: Continuing to smoke after cancer diagnosis has serious implications, leading to compromised treatment effectiveness, reduced survival, increased risk of recurrence, and impaired daily functioning. Despite these risks, about 30-50% of cancer patients continue to smoke and 40-50% of smokers with cancer relapse usually within a few months. Due to the aging of the population, the number of Veterans diagnosed with cancer each year is increasing. To optimize the effectiveness of their cancer treatment and quality of life, increased efforts to promote tobacco cessation within cancer care are needed. Rationale: While many people may consider stopping smoking after a cancer diagnosis to be an obvious decision, an effective tobacco cessation intervention for cancer patients remains elusive. 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. While the role of risk perceptions in behavior change is strongly supported by theory, 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 will create a communication tool that helps patients make sense of the implications of continued smoking and aids providers in having these discussions to increase patient motivation and promote long-term cessation. Specific Aims: Aim 1. Develop a targeted risk communication tool to enhance clinical cessation interventions and educate cancer patients about risks associated with continued tobacco use. We will use patient cognitive interviews to collect feedback on patient reactions to the draft communication tool. Aim 2. Conduct a randomized pilot study (best practices vs. best practices + targeted risk communication) among tobacco-dependent Veterans receiving outpatient cancer care. This pilot (N=118) study will a) provide preliminary data on motivation to quit, tobacco cessation outcomes, and patient acceptability in the Veteran cancer population and test the hypothesis that targeted risk communication will increase motivation to quit, and b) assess costs associated with each intervention arm. Methods: The research will be conducted in two phases. During the first developmental phase, we will work with health communications experts to draft a risk communication tool and refine it further using cognitive interviews with patients. In the second phase we will conduct a randomized pilot project to evaluate the potential of the risk communication tool to improve tobacco cessation outcomes. During a period of 18 months, oncology nurses will provide N=118 VA cancer patients with best-practices cessation treatment (advice, medications, and referral to the state Quitline) alone or in addition to reviewing an informational sheet with plain language explanations and visual representations of diagnosis-specific risk data related to smoking and cancer. 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. This innovative project has implications for improving the design of theory-based tobacco cessation programs and the quality of cancer care within VA.