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。这增加了人们对决策辅助工具的兴趣，这些工具旨在促进患者参与关于他们的护理的决策制定，这些工具提出了真实的选择，每个选择都涉及到伤害和好处。使用决策辅助工具的潜在好处，除了最大限度地提高患者自主权外，还包括提高患者对选择的依从性，并有望改善健康结果。烟草使用是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、个性化的戒烟建议，而不考虑患者的偏好。不幸的是，事实证明，在实际的临床实践中很难推广这种方法。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，但从未被应用于与烟草使用行为相关的决定。选择性外科手术的时间表(每年在大约1000万美国吸烟者中进行)是探索将辅助决策应用于烟草控制的机会。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直接的术后并发症；永久禁欲对长期健康的额外好处是显而易见的。因此，吸烟的外科患者面临三个直接的选择：1)在手术前和手术后立即继续吸烟，2)试图在围手术期暂时戒烟，或3)利用手术作为永久戒烟的机会。因为手术日期代表了一个明确的决策点，所以这一设置是探索使用决策辅助工具来促进临床医生和吸烟者之间讨论烟草使用的新概念的绝佳机会。这项提案的总体目标是开发和试行一种决策辅助工具，该辅助工具将增加患者对计划进行择期手术的吸烟者的吸烟行为的决策参与。在第一个具体目标中，将使用一种新的以实践为基础、以患者为中心的方法来开发一种决策辅助工具，以帮助计划进行择期手术的患者决定是继续吸烟、尝试围手术期暂时戒烟还是尝试持续戒烟。在第二个目标中，计划进行择期手术的吸烟者将被随机安排接受基于通常的“5A”方法的简短干预，或结合特定目标1开发的决策辅助的方法，以检验决策辅助1)将增加关于烟草使用的决策质量的衡量标准的假设，以及2)决策质量的提高将与戒烟意向和自我效能的衡量标准的增加相关。术后的烟草使用也将作为一种探索性结果进行评估。该项目是首次探索旨在为临床医生使用而设计的正式决策辅助工具是否可以帮助患者就他们的烟草使用行为做出决定，这可能会对癌症风险产生广泛影响。 与公共卫生相关：医疗专业人员可以也应该帮助吸烟的患者戒烟，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这些专业人员可以帮助的新方式-使用决策辅助工具来帮助需要手术的吸烟者在手术期间决定如何管理他们的吸烟。由于每年有数以百万计的美国人需要手术，如果新方法成功，它不仅将帮助这些吸烟者在手术后获得更好的结果，还将获得戒烟带来的巨大健康好处。

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.