Decision Aid for Cigarette Smokers Undergoing Surgery

描述（由申请人提供）：患者参与决策被广泛认为是高质量医疗保健的一个特征。这增加了对决策辅助工具的兴趣，这些工具旨在促进患者参与关于其护理的决策，这些决策提供了真正的选择，每个选择都涉及危害和益处。使用决策辅助工具的潜在好处，除了最大限度地提高患者的自主性，还包括增加患者对选择的依从性，并有望改善健康结果。烟草使用是导致包括癌症在内的疾病的唯一最重要的可预防原因。实践指南为临床医生提供的烟草干预措施（“5A”）提供了建议，其中包括强烈的个性化戒烟建议，无论患者的偏好如何。不幸的是，它已被证明很难在实际的临床实践中传播这种方法。决策辅助工具旨在促进临床医生与患者的互动，并可能被证明是帮助临床医生与患者讨论烟草使用的实用工具，但从未应用于与烟草使用行为相关的决策。择期外科手术的安排（每年约有1000万美国吸烟者）为探索烟草控制决策辅助工具的使用提供了机会。对于那些需要择期手术的患者，即使是短暂的围手术期禁欲也能减少术后即刻并发症;永久禁欲对长期健康的额外益处是显而易见的。因此，吸烟的手术患者面临三种直接选择：1）在手术前后立即继续吸烟，2）试图在围手术期保持暂时戒烟，或3）将手术作为永久戒烟的机会。因为手术日期代表了一个坚定的决定点，这个设置是一个很好的机会，探索使用决策辅助工具，以促进临床医生和吸烟者之间的烟草使用的讨论的新概念。本提案的总体目标是开发和试点测试一种决策辅助工具，该工具将增加患者参与有关择期手术吸烟者吸烟行为的决策。在第一个具体目标中，将使用一种基于实践、以患者为中心的新方法来开发决策辅助工具，以帮助计划进行择期手术的患者决定是否继续吸烟、尝试暂时围手术期戒烟或进行持续戒烟尝试。在第二个目标中，计划进行择期手术的吸烟者将随机接受基于通常的“5A”方法或结合特定目标1中开发的决策辅助的方法的简短干预，以测试以下假设：决策辅助1）将增加与烟草使用有关的决策质量指标，2）决策质量的提高将与戒烟意图和自我效能的增加有关。术后烟草使用也将作为探索性结局进行评估。该项目代表了第一次探索，旨在为临床医生使用可行的正式决策辅助工具是否可以帮助患者就其烟草使用行为做出决定，这可能对癌症风险产生广泛影响。 公共卫生相关性：医疗专业人员可以而且应该帮助他们的吸烟患者戒烟，但这可能很困难，因为这些专业人员中很少有人接受过正确的培训，也没有足够的时间这样做。这个项目测试了一种新的方式，这些专业人员可以帮助-通过使用决策辅助工具，以帮助吸烟者谁需要手术决定如何管理他们的吸烟手术前后的时间。由于每年有数百万美国人需要手术，如果新方法成功，它将帮助这些吸烟者不仅在手术后有更好的结果，而且还获得戒烟的巨大健康益处。

DESCRIPTION (provided by applicant): Patient involvement in decision making is widely regarded as a feature of high quality health care. This has increased interest in decision aids, tools designed to facilitate patient participation in decision making about their care that present true choices, each involving harms and benefits. Potential benefits of using decision aids, beyond maximizing patient autonomy, include increased patient compliance with choices, and hopefully, improved health outcomes. Tobacco use is the single most important preventable cause of disease, including cancer. Practice guidelines provide recommendations for clinician-provided tobacco interventions (the "5As"), which include strong, personalized recommendations to quit, regardless of patient preference. Unfortunately, it has proved difficult to disseminate this approach in actual clinical practice. Decision aids are designed to facilitate clinician-patient interactions, and could prove to be practical tools to help clinicians discuss tobacco use with their patients, but have never been applied to decisions related to tobacco use behavior. The scheduling of elective surgical procedures (occurring in approximately 10 million American smokers each year) represents an opportunity to explore the use of decision aids applied to tobacco control. For those requiring elective surgery, even brief perioperative abstinence reduces immediate postoperative complications; the additional benefit to long-term health of permanent abstinence is clear. Surgical patients who smoke thus face three immediate choices: 1) continue to smoke both immediately before and after surgery, 2) attempt to maintain temporary abstinence from smoking in the perioperative period or 3) use surgery as an opportunity to quit smoking for good. Because the surgical date represents a firm point of decision, this setting represents an excellent opportunity to explore the novel concept of using a decision aid to facilitate discussions of tobacco use between clinicians and smokers. The overall goal of this proposal is to develop and pilot test a decision aid that will increase patient involvement in decisions regarding smoking behavior of cigarette smokers scheduled for elective surgery. In the first specific aim, a novel practice-based, patient-centered method will be used to develop a decision aid to help patients scheduled for elective surgery decide whether to continue to smoke, attempt temporary perioperative abstinence, or make a sustained quit attempt. In the second aim, smokers scheduled for elective surgery will be randomized to receive a brief intervention based on the usual "5As" approach or an approach incorporating the decision aid developed in Specific Aim 1 to test the hypotheses that the decision aid 1) will increase measures of decisional quality regarding the tobacco use, and 2) the increased quality of decisions will be associated with increases in measures of intent to quit and self-efficacy. Postoperative tobacco use will also be assessed as an exploratory outcome. This project represents the first exploration of whether a formal decision aid designed to be feasible for clinician use can help patients make decisions regarding their tobacco use behavior, which could have a broad impact on cancer risk. PUBLIC HEALTH RELEVANCE: Medical professionals can and should help their patients who smoke quit, but this can be difficult because few of these professionals have the right training and enough time to do so. This project tests a new way that these professionals can help - by using decision aids to help smokers who need surgery decide how to manage their smoking around the time of surgery. Because millions of Americans require surgery each year, if the new method is successful it will help these smokers not only have better results after surgery, but to also gain the dramatic health benefits of quitting smoking.