Implementing A Virtual Tobacco Treatment in Community Oncology Practices

美国有超过1550万癌症幸存者;存活率在上升，但 不幸的是，10-30%的癌症患者在诊断时是当前吸烟者。 2014年 卫生局局长的报告得出结论，有足够的证据将吸烟与 癌症患者的不良健康结果和B）戒烟改善癌症 预后因此，国家综合癌症网络发表了第一个吸烟 2015年癌症患者的戒烟指南。 一 大多数癌症患者不接受 戒烟支持，特别是循证烟草治疗指南， 尚未在社区癌症环境中实施，其中绝大多数癌症患者 得到照顾。调查小组开发并测试了一个基于证据的 密集烟草治疗（IT），以英语和西班牙语亲自或通过电话提供， 两个综合癌症中心使用创新的实时视频会议技术 ），我们建议在 新成立的ECOG-ACRIN NCI社区肿瘤学附属社区站点 （通过计算机传送） 或移动终端 研究计划（NCORP）。我们将使用混合1型有效性实施试验 设计以检查有效性（7天可替宁证实的点-患病率禁欲在6 两种交付方式。我们将随机抽取224名癌症患者， 吸烟者接受虚拟强化烟草治疗（VIT）或强化烟草护理（EUC）; 戒烟热线转介 和特定地点的常规护理 ). VIT包括扩展的激励 咨询，由一个集中的烟草教练提供，加上12周的尼古丁组合 替代疗法（贴剂加锭剂）。 次要目的将确定患者和NCORP 在普罗克特的指导下， 执行情况研究成果建议和 实施研究（CFIR）。将通过以下方式促进执行工作： 患者退出 访谈（n=40），一年两次与NCORP研究中心PI和工作人员举行会议， NCORP前/后 PI/临床医生/工作人员调查（n=100）和试验后NCORP研究中心焦点小组（n=10）。 这 提案在1）虚拟设计（通过简短视频（Vidscrip）进行临床医生外展）方面具有创新性 和治疗交付），2）获得和有针对性的癌症治疗，以不同的癌症社区 患者，以及3）跨学科团队，包括癌症护理，烟草 治疗、实施和社区癌症试验。示范实施一个 在NCORP站点的视频会议烟草治疗将建立传播途径， 循证烟草治疗，缩小资源稀缺地区治疗提供的差距 社区肿瘤学设置。

There are over 15.5 million cancer survivors in the U.S.; survival rates are increasing, but unfortunately 10-30% of cancer patients are current smokers at the time of diagnosis. The 2014 Surgeon General's report concluded that there is sufficient evidence ) linking smoking to adverse health outcomes in cancer patients and b) that quitting smoking improves cancer prognosis. Accordingly, the National Comprehensive Cancer Network published its first smoking cessation guidelines for patients with cancer in 2015. a Most cancer patients do not receive tobacco cessation support and, specifically, evidence-based tobacco treatment guidelines have not been implemented in community cancer settings where the vast majority of cancer patients receive care. The investigative team developed and tested the integration of an evidence based intensive tobacco treatment (IT), delivered in-person and via phone in English and Spanish, at two comprehensive cancer centers. Using innovative live videoconferencing technology ), we propose a virtual implementation of the IT in community sites affiliated with the newly established ECOG-ACRIN NCI Community Oncology (delivered via computer or mobile device Research Program (NCORP). We will use a Hybrid Type 1 effectiveness-implementation trial design to examine the effectiveness (7-day cotinine confirmed point-prevalence abstinence at 6 months) of two delivery approaches. We will randomize 224 cancer patients who are current smokers to either the virtual intensive tobacco treatment (VIT) or Enhanced Usual Care (EUC; quitline referral and site-specific usual care ). The VIT consists of extended motivational counseling, delivered by a centralized tobacco coach, plus 12 weeks of combination nicotine replacement therapy (patch plus lozenge). Secondary aims will identify patient and NCORP sites characteristics associated with VIT effectiveness and implementation, guided by Proctor's' implementation research outcome recommendations and the Consolidated Framework for Implementation Research (CFIR). Implementation will be facilitated through patient exit interviews (n=40), biannual meetings with NCORP site PIs and staff, pre/post NCORP PI/clinicians/staff surveys (n=100), and post-trial NCORP site focus groups (n=10). This proposal is innovative in its 1) virtual design (clinician outreach through brief videos (Vidscrip) and treatment delivery), 2) access and targeted cancer treatment to diverse cancer community patients, and 3) transdisciplinary team, which includes experts in cancer care, tobacco treatment, implementation, and community cancer trials. Demonstrating the implementation of a videoconferencing tobacco treatment at NCORP sites will establish a pathway for disseminating evidence based tobacco treatment and close the gap of treatment delivery in resource sparse community oncology settings.