Implementing A Virtual Tobacco Treatment in Community Oncology Practices

美国有超过1550万癌症幸存者；存活率正在上升，但 不幸的是，10%-30%的癌症患者在确诊时是当前吸烟者。 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后果以及b)戒烟可改善癌症 预后。因此，国家综合癌症网络发布了它的第一份吸烟报告 2015年癌症患者的戒烟指南。 一个 大多数癌症患者不会收到 戒烟支持，特别是循证烟草治疗指南 没有在社区癌症环境中实施，在那里绝大多数癌症患者 接受治疗。调查小组开发并测试了基于证据的 强化烟草治疗(IT)，以英语和西班牙语面对面和通过电话提供， 两个综合性癌症中心。使用创新的实时视频会议技术 )，我们提出了IT的虚拟实施方案 与新成立的ECOG-ACRIN NCI社区肿瘤学有关的社区站点 (通过计算机交付 或移动设备 研究计划(NCORP)。我们将使用混合类型1有效性-实施试验 检查有效性的设计(7天可替宁确认6点流行戒断 几个月)的两种交付方式。我们将随机抽取224名现役癌症患者 吸烟者接受虚拟强化烟草治疗(VIT)或加强日常护理(EUC； Quitline转诊 和特定地点的日常护理 )。VIT由扩展的动机组成 咨询，由中央烟草教练提供，外加12周的组合尼古丁 替代疗法(贴片加含片)。 二级目标将确定患者和NCORP 与VIT有效性和实施相关的站点特征，由Proctor的指导 执行研究成果建议和综合框架 实施研究(CFIR)。将通过以下方式促进实施 病人出口 约谈(n=40)，与NCORP现场PI和工作人员举行一年两次的会议， NCORP前/后 PI/临床医生/工作人员调查(n=100)和试验后NCORP现场焦点小组(n=10)。 这 提案在1)虚拟设计方面具有创新性(临床医生通过简短视频(Vidcrip)进行推广) 和治疗提供)，2)获得不同癌症社区的机会和有针对性的癌症治疗 患者，以及3)跨学科团队，其中包括癌症护理、烟草专家 治疗、实施和社区癌症试验。演示如何实施 在NCORP地点举行烟草治疗电视会议将建立一条传播途径 循证烟草治疗与弥补资源稀缺中的治疗差距 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.