Testing the association of 5A smoking advice patterns with novel patient outcomes

描述(由申请人提供)：烟草使用仍然是美国发病率和发病率的主要、可预防的原因之一，初级保健临床医生具有独特的地位，可以为大部分人口提供简短的建议。建议在初级保健环境中使用5AS框架(询问、建议、评估、协助、安排)进行简短的戒烟咨询。系统评估表明，基于5A的咨询与戒烟之间存在适度的正相关；然而，大多数5A评估依赖于临床医生回忆、患者回忆或医疗记录审查，这可能导致对实际临床医生行为的过多或过少报告。此外，几乎没有数据来阐明5A的完整性和适当的交付顺序对患者预后的影响。准确衡量低强度干预措施的影响，如基于5AS框架的简短临床医生建议，需要可靠、对变化敏感、适用于所有患者戒烟准备水平并与戒烟相关的患者结果衡量标准。我们的研究团队开发了两种创新措施来应对这些方法挑战。首先，我们开发了5A直接观察编码方案(5A-DOC)，它使用临床医生与患者的交谈来确定每个A的完成程度。5A-DOC是可靠、有效的，建议可以根据A的提供的完整性和适当的顺序进行分类。第二，我们使用RASCH分析开发了一种创新的戒烟增量行为改变测量方法(IBC-S)。该测量可靠、对变化敏感，并与戒烟相关。通过将用于开发5A-DOC的131个病例的初始样本的数据与一项新研究相结合，我们可以将5A-DOC应用于59名初级保健临床医生的774个病例，并使用具有足够能力的多水平建模来测试与戒烟相关结果的关联。在两项研究中，患者的结果，包括IBC-S，都是平行的。研究2中的一组患者完成了一项调查，评估每个5A元素的接收情况，以便我们可以将患者报告与5A-DOC进行比较。我们有一个令人信服的机会来研究以下研究问题：完全交付5A元素对中间患者结果(即患者对建议的回忆、渐进的行为改变、香烟数量的减少和报告的戒烟)有什么影响？5A元素的交付顺序对中间患者的预后有什么影响？与直接观察编码系统相比，患者报告5A要素的准确性如何？这项工作对评估5A的研究人员、临床医生的教育工作者非常重要，并最终可能影响初级保健环境中戒烟建议的效率和有效性。

DESCRIPTION (provided by applicant): Tobacco use continues to be one of the leading, preventable causes of morbidity and morbidity in the United States and primary care clinicians are in a unique position to provide brief advice to a large portion of the population. The 5As framework (ASK, ADVISE, ASSESS, ASSIST, ARRANGE) is recommended for brief smoking cessation counseling in the primary care context. Systematic reviews indicate a moderate positive association between counseling based on the 5As and abstinence from smoking; however most 5A assessments rely on clinician recall, patient recall or medical record review that may lead to over or under-reporting of actual clinician behavior. Further, there is little dat to elucidate the effect of the completeness and appropriate sequence of delivery of the 5As on patient outcomes. Accurately measuring the impact of low intensity interventions, like brief clinician advice based on the 5As framework, requires a patient outcome measure that is reliable, sensitive to change, applicable to the full spectrum of patient level of readiness for smoking cessation and associated with smoking abstinence. Our study team has developed two innovative measures to address these methodologic challenges. First, we developed the 5As Direct Observation Coding scheme (5A-DOC) that uses clinician-patient talk to determine the degree to which each of the 'A's are accomplished. The 5A-DOC is reliable, valid and advice can be classified with regard to completeness and appropriate sequencing of delivery of the 'A's. Second, using Rasch analysis we developed an innovative measure of Incremental Behavior Change for smoking cessation (IBC- S).This measure is reliable, sensitive to change and associated with smoking cessation. By pooling data from the initial sample of 131 cases used to develop the 5A-DOC with a new study, we can apply the 5A-DOC to 774 cases across 59 primary care clinicians and test associations with smoking cessation-related outcomes using multilevel modeling with adequate power. Patient outcomes, including the IBC-S, are parallel across both studies. A subsample of patients in Study 2 completed a survey assessing receipt of each 5A element such that we can compare patient report to the 5A-DOC. We have a compelling opportunity to examine the following research questions: What is the effect of complete delivery of the 5A elements on intermediate patient outcomes (i.e. patient recall of the advice, incremental behavior change, reduction in the number of cigarettes, and reported smoking cessation)? What is the effect of the sequence of delivery of the 5A elements on intermediate patient outcomes? How accurate are patient reports of the 5A elements compared to a direct observation coding system? This work is important to researchers assessing the 5As, educators of clinicians and ultimately can impact the efficiency and effectiveness of cessation advice in the primary care setting.