Testing a Clinician and Patient Intervention to Promote smoking Cessation Among Pregnant Women

测试临床医生和患者的干预措施以促进孕妇戒烟

• 批准号: 10643940
• 负责人: JUDY C CHANG
• 金额: $ 55.53万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10643940
• 关键词: Abstinence; Biochemical; Clip; Communication; Communication Programs; Counseling; Coupling; Discipline of obstetrics; Double Effect; Educational process of instructing; Equation; Evidence based intervention; Exercise; Feedback; Guidelines; Health Care Costs; Individual; Infant Care; Intervention; Learning; Light; Low Birth Weight Infant; Meta-Analysis; Modeling; Mothers; Oncologist; Online Systems; Outcome; Outcome Assessment; Patients; Perception; Perinatal; Phase; Postpartum Abstinence; Postpartum Period; Pregnancy; Pregnancy Outcome; Pregnant Women; Premature Birth; Public Health; Randomized; Randomized, Controlled Trials; Reporting; Self Efficacy; Site; Smoke; Smoking; Suggestion; Testing; Text; Text Messaging; Touch sensation; Training; Training Programs; United States; Woman; Work; arm; comparison control; cost; design; expectation; improved; individualized feedback; infant death; infant morbidity/mortality; intervention effect; maternal morbidity; negative affect; neonatal morbidity; pediatrician; pilot test; post intervention; pregnant; primary outcome; programs; recruit; secondary outcome; skills; smoking abstinence; smoking cessation; smoking during pregnancy; text messaging intervention; theories; treatment arm; web-based intervention

Perinatal smoking negatively affects the baby and mother as well as healthcare costs; yet, up to one third of women who smoke continue to do so during pregnancy. We tested an SMS texting program and found we could help 10% quit. This quit rate is promising given the light touch and far‐reach of a texting intervention. We want to build on this work to help more pregnant women quit. We will pair the texting intervention with another far‐reaching intervention, clinician counseling —an evidence‐based intervention that has been shown to increase rates of smoking cessation. Despite national guidelines to implement the 5 Aʹs—Ask, Advise, Assess, Assist and Arrange—most obstetric clinicians only Ask and Advise, the least effective of the five. By improving OB clinicians' smoking cessation counseling skills, we can potentially double the effect of the SMS texting program and twice as many women quit. We have already designed and piloted an interactive, individually‐tailored, web‐based communication training program. The program uses clips from OB clinicians' own audio‐recorded encounters, and provides constructive, individualized feedback and suggestions for incorporating the 5 Aʹs. The program is modeled after our other communication training programs that successfully improved pediatrician use of the 5 Aʹs and oncologist use of empathic communication. We propose a randomized, controlled trial to assess whether use of the communication program improves cessation rates among pregnant women who smoke and whether it improves OB clinician smoking cessation counseling. First, we will recruit 50 clinicians and will audio record 4 encounters in the Pre‐ Intervention Phase that will be used to tailor the intervention and assess baseline communication skills. Then, we will randomize half of the clinicians to receive a tailored, web‐based intervention that contains didactic information interactive exercises, and audio clips from their Pre‐Intervention recordings to promote their use of the 5 Aʹs. Clinicians in the control arm will receive the standard smoking cessation counseling web‐based designed for obstetricians. We will recruit 550 patients (11 per clinician), all who will receive the texting intervention, and will audio record their encounters. We will use an intent‐to‐treat analysis to compare our primary outcome, biochemically‐validated cessation at the end of pregnancy, among patients of intervention (n=275) and patients of control OB clinicians (n=275). Additionally, we will assess clinician use of the 5A's in smoking cessation counseling, patient perceptions of communication as well as smoking postpartum. If successful, this program would have an exponential impact on increasing smoking cessation and improving pregnancy outcomes.

围产期吸烟对婴儿和母亲以及医疗保健费用产生负面影响;然而， 吸烟的妇女在怀孕期间继续吸烟。我们测试了一个短信程序，发现我们 可以帮助10%的人戒烟考虑到短信干预的轻触和深远影响，这一戒烟率是有希望的。 我们希望在这项工作的基础上帮助更多的孕妇戒烟。我们将短信干预与 另一个影响深远的干预措施，临床医生咨询-一个基于证据的干预措施，已被证明 提高戒烟率。尽管国家指导方针，以执行5A咨询，建议， 评估，协助和咨询-大多数产科医生只问和建议，最有效的五个。通过 提高OB临床医生的戒烟咨询技能，我们可能会使SMS的效果翻倍 而退出的女性人数是男性的两倍。我们已经设计并试验了一个互动的， 个性化定制的基于网络的沟通培训计划该计划使用的剪辑从OB 临床医生自己的音频记录的遭遇，并提供建设性的，个性化的反馈， 建议纳入5个A级。该计划是仿照我们的其他通信培训 这些项目成功地改善了儿科医生对5 A的使用， 通信我们建议进行一项随机对照试验，以评估是否使用通信 该计划提高了吸烟孕妇的戒烟率，以及它是否改善了OB临床医生 戒烟咨询。首先，我们将招募50名临床医生，并将在预测试中录音4次。 干预阶段，将用于定制干预和评估基线沟通技能。然后， 我们将随机分配一半的临床医生接受量身定制的基于网络的干预， 信息互动练习和干预前录音的音频剪辑，以促进其使用 5A的。对照组的临床医生将接受基于网络的标准戒烟咨询。 专为产科医生设计我们将招募550名患者（每位临床医生11名），所有患者都将收到短信 干预，并将录音记录他们的遭遇。我们将使用意向治疗分析来比较我们的 干预患者的主要结局，妊娠结束时经生化验证的停药 （n=275）和对照OB临床医生的患者（n=275）。此外，我们将评估临床医生在以下方面使用5A的情况： 戒烟咨询、患者对沟通的看法以及产后吸烟。如果 如果成功，该计划将对增加戒烟和改善吸烟率产生指数影响。 妊娠结局。