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Jaeb MA, Pecanac KE. Shame in patient-health professional encounters: A scoping review. Int J Ment Health Nurs 2024. [PMID: 38500241 DOI: 10.1111/inm.13323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/21/2024] [Accepted: 03/06/2024] [Indexed: 03/20/2024]
Abstract
Shame can arise during patient-health professional encounters when discussing traumatising and stigmatising topics and can contribute to negative patient outcomes. This review aims to summarise what is known regarding shame in patient-health professional encounters. We conducted a scoping review using Levac and colleagues' approach and reported the findings using the PRISMA Extension for Scoping Reviews. We searched four databases (CINAHL, PsychINFO, PubMed and SocINDEX) for empirical studies that involved shame in patient-health professional encounters contextualised by trauma or stigma and were published in English. We categorised what is known regarding shame in empirical studies using inductive content analysis. We also collected stakeholders' perspectives on the review findings through an online survey. Our initial search yielded 3658 articles, of which 37 were included. We summarised the literature into four categories: (1) What health professionals say they do in patient-health professional encounters, (2) What health professionals think patients feel in patient-health professional encounters, (3) Patients' descriptions of their own shame during patient-health professional encounters and (4) Health professionals' descriptions of their own shame during patient-health professional encounters. Shame can arise in a variety of circumstances during patient-health professional encounters. More research is needed to identify what specific communication strategies used by health professionals during patient-health professional encounters contribute to or avoid patient shame.
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Affiliation(s)
- Michael A Jaeb
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Kristen E Pecanac
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
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2
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Vikram A, Muller C, Hulme L. Patients' Views on Medical Events in Lung Cancer Screening as Teachable Moments for Smoking Behaviour Change: A Systematic Review and Metasynthesis. J Smok Cessat 2023; 2023:6647364. [PMID: 37305439 PMCID: PMC10257552 DOI: 10.1155/2023/6647364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 06/13/2023] Open
Abstract
Although medical events in lung cancer screening (LCS) such as receiving scan results or interactions with clinicians are recognised as teachable moments (TMs), the views of patients about why this is the case for smoking behaviour change remain uncertain. This systematic review and metasynthesis study is aimed at identifying the reasons why patients believed that medical events during LCS act as TMs for smoking behaviour change. A search strategy was developed for use with MEDLINE, PsycINFO, EMBASE, CINAHL-P, Web of Science databases, and Google Scholar. This helped identify qualitative and mixed-method research which mentioned patients' views of how these TMs result in smoking behaviour change. After screening, final articles were critically appraised; general characteristics and data relevant to the aims were extracted to conduct a line-of-argument metasynthesis. After screening 695 papers, 11 were included. Undergoing LCS scans was seen to act on their intrinsic motivation to reduce smoking as it served as a "wake-up call" and increased awareness of the health consequences of smoking. Receiving positive or negative LCS results resulted in cessation as it was a "health scare" and challenged smoking habits. Interactions with clinicians addressed misconceptions and signposted them to specialist cessation services. Attendees believed that the following encouraged them to change their smoking behaviour: having an intrinsic motivation to quit, their beliefs on smoking and health reframed, their negative emotions appraised, and using LCS to access specialist support. In line with the TM heuristic, these experiences provided the necessary skills, confidence, and motivation to quit. Future research should explore whether the views of the clinicians match those of the attendees to address misconceptions and further develop clinical guidelines.
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Affiliation(s)
- Anvita Vikram
- Pennine Care NHS Foundation Trust, Manchester BL9 0EQ, UK
| | - Claire Muller
- The University of Manchester, Manchester M13 9PL, UK
| | - Lucy Hulme
- The University of Manchester, Manchester M13 9PL, UK
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3
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Chen J, Cutrona SL, Dharod A, Bunch SC, Foley KL, Ostasiewski B, Hale ER, Bridges A, Moses A, Donny EC, Sutfin EL, Houston TK. Monitoring the Implementation of Tobacco Cessation Support Tools: Using Novel Electronic Health Record Activity Metrics. JMIR Med Inform 2023; 11:e43097. [PMID: 36862466 PMCID: PMC10020903 DOI: 10.2196/43097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/21/2022] [Accepted: 01/18/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Clinical decision support (CDS) tools in electronic health records (EHRs) are often used as core strategies to support quality improvement programs in the clinical setting. Monitoring the impact (intended and unintended) of these tools is crucial for program evaluation and adaptation. Existing approaches for monitoring typically rely on health care providers' self-reports or direct observation of clinical workflows, which require substantial data collection efforts and are prone to reporting bias. OBJECTIVE This study aims to develop a novel monitoring method leveraging EHR activity data and demonstrate its use in monitoring the CDS tools implemented by a tobacco cessation program sponsored by the National Cancer Institute's Cancer Center Cessation Initiative (C3I). METHODS We developed EHR-based metrics to monitor the implementation of two CDS tools: (1) a screening alert reminding clinic staff to complete the smoking assessment and (2) a support alert prompting health care providers to discuss support and treatment options, including referral to a cessation clinic. Using EHR activity data, we measured the completion (encounter-level alert completion rate) and burden (the number of times an alert was fired before completion and time spent handling the alert) of the CDS tools. We report metrics tracked for 12 months post implementation, comparing 7 cancer clinics (2 clinics implemented the screening alert and 5 implemented both alerts) within a C3I center, and identify areas to improve alert design and adoption. RESULTS The screening alert fired in 5121 encounters during the 12 months post implementation. The encounter-level alert completion rate (clinic staff acknowledged completion of screening in EHR: 0.55; clinic staff completed EHR documentation of screening results: 0.32) remained stable over time but varied considerably across clinics. The support alert fired in 1074 encounters during the 12 months. Providers acted upon (ie, not postponed) the support alert in 87.3% (n=938) of encounters, identified a patient ready to quit in 12% (n=129) of encounters, and ordered a referral to the cessation clinic in 2% (n=22) of encounters. With respect to alert burden, on average, both alerts fired over 2 times (screening alert: 2.7; support alert: 2.1) before completion; time spent postponing the screening alert was similar to completing (52 vs 53 seconds) the alert, and time spent postponing the support alert was more than completing (67 vs 50 seconds) the alert per encounter. These findings inform four areas where the alert design and use can be improved: (1) improving alert adoption and completion through local adaptation, (2) improving support alert efficacy by additional strategies including training in provider-patient communication, (3) improving the accuracy of tracking for alert completion, and (4) balancing alert efficacy with the burden. CONCLUSIONS EHR activity metrics were able to monitor the success and burden of tobacco cessation alerts, allowing for a more nuanced understanding of potential trade-offs associated with alert implementation. These metrics can be used to guide implementation adaptation and are scalable across diverse settings.
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Affiliation(s)
- Jinying Chen
- iDAPT Implementation Science Center for Cancer Control, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Department of Preventive Medicine and Epidemiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Sarah L Cutrona
- iDAPT Implementation Science Center for Cancer Control, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Ajay Dharod
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Wake Forest Center for Healthcare Innovation, Winston-Salem, NC, United States
- Wake Forest Center for Biomedical Informatics, Winston-Salem, NC, United States
| | - Stephanie C Bunch
- Center for Health Analytics, Media, and Policy, RTI International, Research Triangle Park, NC, United States
| | - Kristie L Foley
- iDAPT Implementation Science Center for Cancer Control, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Brian Ostasiewski
- Clinical & Translational Science Institute, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Erica R Hale
- iDAPT Implementation Science Center for Cancer Control, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Aaron Bridges
- Clinical & Translational Science Institute, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Adam Moses
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Thomas K Houston
- iDAPT Implementation Science Center for Cancer Control, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
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Land SR, Baker L, Twesten J, Reyes-Guzman CM, Kaufman AR. Smoking Cessation and Tobacco-related Risk Perceptions among People with and without a Diagnosis of Cancer. Cancer Epidemiol Biomarkers Prev 2023; 32:266-273. [PMID: 36480285 PMCID: PMC9905258 DOI: 10.1158/1055-9965.epi-22-0651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/31/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Little is known about how cancer diagnosis and tobacco-related risk perceptions are associated with smoking behavior. METHODS We used data from Waves (W) 1-3 (2013-2016) of the Population Assessment of Tobacco and Health Study to analyze longitudinal smoking behavior among adults who were current smokers and not previously diagnosed with cancer at baseline (W1; N = 7,829). The outcome was smoking cessation as of follow-up (W3). Explanatory variables were sociodemographics, other tobacco product use, adult at first cigarette, tobacco dependence, cancer diagnosis after baseline, and tobacco-related risk perceptions [cigarette harm perception, worry that tobacco products will damage one's health ("worry"), belief that smoking causes cancer ("belief"), and nondaily smoking harm perception]. RESULTS Cessation was significantly associated with baseline worry (OR = 1.26; 95% confidence interval, 1.13-1.40), follow-up cigarette harm perception [OR = 2.01 (1.77-2.29)], and follow-up belief [OR = 1.40 (1.20-1.63)]. Cessation was inversely associated with follow-up (W3) worry, and this association was stronger among those without a cancer diagnosis (OR = 0.37 without cancer; OR = 0.76 among individuals diagnosed with cancer; interaction P = 0.001). CONCLUSIONS Cessation is associated with tobacco-related risk perceptions, with different perceptions contributing in unique ways. Cessation is predicted by baseline worry but is inversely associated with worry at follow-up, suggesting that perhaps cessation has alleviated worry. The latter finding was stronger among respondents not diagnosed with cancer. IMPACT Associations between cancer diagnosis, tobacco-related risk perceptions, and smoking behavior may inform the development of evidence-based smoking cessation interventions.
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Affiliation(s)
| | - Laura Baker
- The Bizzell Group, LLC, New Carrollton, Maryland
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5
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Marshall ME, Shields CG, Alexander SC. "Do You Smoke?" Physician-Patient Conversations About Smoking and Lung Cancer. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1967-1974. [PMID: 34264511 DOI: 10.1007/s13187-021-02067-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/03/2021] [Indexed: 06/13/2023]
Abstract
This study examined how physicians initiated and navigated conversations about smoking with patients with lung cancer. While there are numerous health benefits associated with smoking cessation in patients with advanced lung cancer, conversations about smoking cessation are infrequent and often lack tangible cessation support. We conducted a qualitative inductive content analysis on transcripts of conversations (n = 58) recorded during an initial appointment between a physician and a standardized patient (SP). SPs portrayed a 62-year-old male with lung cancer completing an initial visit with a new physician. Qualitative analysis focused on examining how physicians discussed smoking with a new patient. We found that a majority of physicians initiated conversations about smoking, often during the medical history charting process or during conversations about the lung cancer diagnosis. The content of conversations about smoking generally fits within six categories: assesses smoking status, builds smoking history profile, praises smoking cessation, connects smoking behaviors to diagnosis or treatment, provides empathy or understanding, and presents a negative bias about smoking. We found that while a majority of physicians asked patients about smoking, most physicians aimed for these conversations to be short, routine, and medically driven. Conversations about smoking were not tailored to meet the specific needs of patients with lung cancer, which might include additional provision of support for smoking cessation and recognition of smoking-related stigma.
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Affiliation(s)
- Mary E Marshall
- Department of Family and Consumer Sciences, California State University Long Beach, Long Beach, CA, USA.
| | - Cleveland G Shields
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN, USA
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6
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Ryan A, Young AL, Tait J, McCarter K, McEnallay M, Day F, McLennan J, Segan C, Blanchard G, Healey L, Avery S, White S, Vinod S, Bradford L, Paul CL. Building staff capability, opportunity, and motivation to provide smoking cessation to people with cancer in Australian cancer treatment centres: development of an implementation intervention framework for the Care to Quit cluster randomised controlled trial. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2022; 23:1-33. [PMID: 36193179 PMCID: PMC9517978 DOI: 10.1007/s10742-022-00288-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 07/26/2022] [Accepted: 08/12/2022] [Indexed: 11/24/2022]
Abstract
Few rigorous studies provide a clear description of the methodological approach of developing an evidence-based implementation intervention, prior to implementation at scale. This study describes the development, mapping, rating, and review of the implementation strategies for the Care to Quit smoking cessation trial, prior to application in nine cancer services across Australia. Key stakeholders were engaged in the process from conception through to rating, reviewing and refinement of strategies and principles. An initial scoping review identified 21 barriers to provision of evidence-based smoking cessation care to patients with cancer, which were mapped to the Theoretical Domains Framework and Behaviour Change Wheel (BCW) to identify relevant intervention functions. The mapping identified 26 relevant behaviour change techniques, summarised into 11 implementation strategies. The implementation strategies were rated and reviewed against the BCW Affordability, Practicality, Effectiveness and cost-effectiveness, Acceptability, Side-effects/safety, and Equity criteria by key stakeholders during two interactive workshops to facilitate a focus on feasible interventions likely to resonate with clinical staff. The implementation strategies and associated intervention tools were then collated by form and function to provide a practical guide for implementing the intervention. This study illustrates the rigorous use of theories and frameworks to arrive at a practical intervention guide, with potential to inform future replication and scalability of evidence-based implementation across a range of health service settings. Supplementary Information The online version contains supplementary material available at 10.1007/s10742-022-00288-6.
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Affiliation(s)
- Annika Ryan
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, John Hunter Hospital, Level 4 West, New Lambton Heights, Newcastle, NSW Australia
| | - Alison Luk Young
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW Australia
| | - Jordan Tait
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, John Hunter Hospital, Level 4 West, New Lambton Heights, Newcastle, NSW Australia
| | - Kristen McCarter
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, John Hunter Hospital, Level 4 West, New Lambton Heights, Newcastle, NSW Australia
- Priority Research Centre for Cancer Research, Innovation and Translation, University of Newcastle, 2308, Callaghan, NSW Australia
- Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW Australia
| | - Melissa McEnallay
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, John Hunter Hospital, Level 4 West, New Lambton Heights, Newcastle, NSW Australia
- Priority Research Centre for Cancer Research, Innovation and Translation, University of Newcastle, 2308, Callaghan, NSW Australia
- Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW Australia
| | - Fiona Day
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW Australia
- Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW Australia
- Calvary Mater Newcastle, Corner Edith and Platt Streets, Waratah, NSW 2289 Australia
| | - James McLennan
- St Vincent’s Hospital Sydney, 390 Victoria Street, Darlinghurst, NSW 2010 Australia
| | - Catherine Segan
- Cancer Council Victoria, Melbourne, VIC Australia
- School of Population and Global Health, Centre for Health Policy, The University of Melbourne, MelbourneMelbourne, VIC Australia
| | - Gillian Blanchard
- Calvary Mater Newcastle, Corner Edith and Platt Streets, Waratah, NSW 2289 Australia
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW Australia
| | - Laura Healey
- Calvary Mater Newcastle, Corner Edith and Platt Streets, Waratah, NSW 2289 Australia
| | - Sandra Avery
- South Western Sydney Local Health District, Elizabeth Street, Liverpool, NSW 2170 Australia
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW Australia
| | - Sarah White
- Department of Health Quitline, 615 St Kilda Rd, Melbourne, VIC 3004 Australia
| | - Shalini Vinod
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW Australia
- South Western Sydney Clinical School and Ingham Institute for Applied Medical Research, Liverpool, NSW Australia
| | - Linda Bradford
- The Alfred, 55 Commercial Rd, Melbourne, VIC 3004 Australia
| | - Christine L. Paul
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, John Hunter Hospital, Level 4 West, New Lambton Heights, Newcastle, NSW Australia
- Priority Research Centre for Cancer Research, Innovation and Translation, University of Newcastle, 2308, Callaghan, NSW Australia
- Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW Australia
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7
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Goshe BM, Rasmussen AW, Wagner LI, Sicks JD, Gareen IF, Carlos RC, Herman BA, Walter AW, Regan S, Levy DE, Mahon I, Muzikansky A, Neil JM, Lui M, Dilip D, Malloy L, Gonzalez I, Finkelstein-Fox L, McCann C, Perez E, Ostroff JS, Park ER. Study protocol for a hybrid type 1 effectiveness-implementation trial testing virtual tobacco treatment in oncology practices [Smokefree Support Study 2.0]. BMC Public Health 2022; 22:1359. [PMID: 35841024 PMCID: PMC9284951 DOI: 10.1186/s12889-022-13631-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/13/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Persistent smoking among patients diagnosed with cancer is associated with adverse clinical outcomes, yet an evidence-based tobacco use intervention has not been well-integrated into cancer care in community oncology settings. This paper describes the protocol of a nation-wide clinical trial conducted by the ECOG-ACRIN National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base to assess the effectiveness of a virtual tobacco treatment intervention and the process of implementing tobacco treatment in NCORP community oncology settings. METHODS/DESIGN This two-arm, multisite (n: 49 NCORP sites) hybrid type 1 effectiveness-implementation randomized controlled trial compares the effectiveness of a Virtual Intervention Treatment (VIT) versus an Enhanced Usual Control (EUC) among English and Spanish speaking patients recently diagnosed with cancer, reporting current smoking and receiving care at a participating NCORP Community or Minority/Underserved Site. The VIT includes up to 11 virtual counseling sessions with a tobacco treatment specialist and up to 12 weeks of nicotine replacement therapy (NRT). The EUC arm receives a referral to the NCI Quitline. The primary study outcome is biochemically confirmed 7-day point prevalence smoking abstinence. Moderators of treatment effect will be assessed. The study evaluates implementation processes from participating NCORP site staff via survey, administrative, and focus group data, including reach, acceptability, appropriateness, fidelity, feasibility, adoption, cost and sustainability outcomes. DISCUSSION This trial will generate findings about the effectiveness of an evidence-based virtual tobacco treatment intervention targeting patients diagnosed with cancer and illuminate barriers and facilitators that influence implementing tobacco treatment into community oncology settings nationally. In the era of COVID-19, virtual care solutions are vital for maximizing access and utilization of tobacco treatment delivery. TRIAL REGISTRATION ClinicalTrials.gov (NCT03808818) on January 18th, 2019; Last update posted: May 21st, 2020.
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Affiliation(s)
- Brett M. Goshe
- grid.38142.3c000000041936754XDepartment of Psychiatry, Massachusetts General Hospital / Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA 02114 USA ,grid.32224.350000 0004 0386 9924Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA USA ,grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Autumn W. Rasmussen
- grid.38142.3c000000041936754XDepartment of Psychiatry, Massachusetts General Hospital / Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA 02114 USA ,grid.32224.350000 0004 0386 9924Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA USA ,grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA
| | - Lynne I. Wagner
- grid.241167.70000 0001 2185 3318Wake Forest University School of Medicine, Winston-Salem, NC USA
| | - JoRean D. Sicks
- grid.40263.330000 0004 1936 9094ECOG-ACRIN Biostatistics Center, Brown University, Providence, RI USA
| | - Ilana F. Gareen
- grid.40263.330000 0004 1936 9094Department of Epidemiology and the Center for Statistical Sciences, Brown University School of Public Health, Providence, RI USA
| | - Ruth C. Carlos
- grid.214458.e0000000086837370Michigan Medicine, University of Michigan, Ann Arbor, MI USA
| | - Benjamin A. Herman
- grid.40263.330000 0004 1936 9094ECOG-ACRIN Biostatistics Center, Brown University, Providence, RI USA
| | - Angela Wangari Walter
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA ,grid.225262.30000 0000 9620 1122Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA USA
| | - Susan Regan
- grid.32224.350000 0004 0386 9924Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Douglas E. Levy
- grid.32224.350000 0004 0386 9924Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Irene Mahon
- grid.417949.60000 0004 0638 1385 ECOG-ACRIN Cancer Research Group, American College of Radiology, Philadelphia, PA USA
| | - Alona Muzikansky
- grid.32224.350000 0004 0386 9924Biostatistics Center, Massachusetts General Hospital, Boston, MA USA
| | - Jordan M. Neil
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA ,grid.266902.90000 0001 2179 3618Department of Family and Preventative Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Michelle Lui
- grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Deepika Dilip
- grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Laura Malloy
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA
| | - Irina Gonzalez
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA
| | - Lucy Finkelstein-Fox
- grid.38142.3c000000041936754XDepartment of Psychiatry, Massachusetts General Hospital / Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA 02114 USA ,grid.32224.350000 0004 0386 9924Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA USA ,grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Caitlin McCann
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA
| | - Elissa Perez
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA
| | - Jamie S. Ostroff
- grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA ,grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Elyse R. Park
- grid.38142.3c000000041936754XDepartment of Psychiatry, Massachusetts General Hospital / Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA 02114 USA ,grid.32224.350000 0004 0386 9924Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA USA ,grid.32224.350000 0004 0386 9924Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
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Delnevo CD, Jeong M, Teotia A, Bover Manderski MM, Singh B, Hrywna M, Wackowski OA, Steinberg MB. Communication Between US Physicians and Patients Regarding Electronic Cigarette Use. JAMA Netw Open 2022; 5:e226692. [PMID: 35426926 PMCID: PMC9012960 DOI: 10.1001/jamanetworkopen.2022.6692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
IMPORTANCE Physicians play a primary role in patient smoking cessation, yet their communication regarding e-cigarettes is not well understood. OBJECTIVE To assess physician-patient communication regarding e-cigarettes. DESIGN, SETTING, AND PARTICIPANTS A national cross-sectional survey in 2018 and 2019 was conducted. Participants were invited by mail; surveys were completed online. Respondents were 2058 board-certified physicians from family medicine, internal medicine, obstetrics and gynecology, cardiology, pulmonary, and oncology. Data were analyzed from August to September 2021. EXPOSURES Physician demographic characteristics, tobacco use, medical specialty, and harm-reduction beliefs (ie, not all tobacco products are equally harmful) applied within 2 hypothetical clinical scenarios. MAIN OUTCOMES AND MEASURES Physicians' self-reported e-cigarette communication (being asked about e-cigarettes by patients and recommending e-cigarettes to patients) and hypothetical e-cigarette communication in 2 clinical scenarios. RESULTS Among 2058 physicians, the mean (SD) age was 51.6 (10.5) years, and 1173 (58.5%) were male. More than 60% of physicians believed all tobacco products to be equally harmful. Overall, 69.8% of physicians reported ever being asked about e-cigarettes by their patients (35.9% in the past 30 days), and 21.7% reported ever recommending e-cigarettes to a patient (9.8% in the past 30 days). Pulmonologists (adjusted odds ratio [aOR], 2.14, 95% CI, 1.10-4.16) and cardiologists (aOR, 2.04; 95% CI, 1.03-4.05), as well as physicians who implemented the US Public Health Service Clinical Practice Guidelines (aOR, 1.77; 95% CI, 1.12-2.80), had greater odds of recommending e-cigarettes to patients. Physicians who endorsed a harm-reduction perspective (aOR, 3.04, 95% CI, 2.15-4.31) and had ever smoked cigarettes (aOR, 1.98; 95% CI, 1.27-3.08) were significantly more likely to recommend e-cigarettes. Physicians who reported being asked about e-cigarettes had greater odds of recommending e-cigarettes (aOR, 16.60; 95% CI, 10.33-26.68). In clinical scenarios, physicians were overall more likely to recommend e-cigarettes for cessation to an older heavy smoker with multiple unsuccessful quit attempts (49.3%; 95% CI, 47.1%-51.4%) than a younger light smoker with no prior cessation treatments (15.2%; 95% CI, 13.6%-16.7%) (P < .001). CONCLUSIONS AND RELEVANCE In this survey study of physicians, findings suggest that physicians may recommend switching to e-cigarettes for some patients who smoke cigarettes under certain circumstances, presumably for cessation. The belief that all tobacco products are equally harmful was associated with lower rates of recommending e-cigarettes. As the evidence base grows for e-cigarette efficacy for smoking cessation, there is need for physician education regarding e-cigarette efficacy.
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Affiliation(s)
- Cristine D. Delnevo
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey
| | - Michelle Jeong
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey
| | - Arjun Teotia
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey
| | | | - Binu Singh
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey
| | - Mary Hrywna
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey
| | - Olivia A. Wackowski
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey
| | - Michael B. Steinberg
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Santi SA, Conlon MSC, Meigs ML, Davidson SM, Mispel-Beyer K, Saunders DP. Rates of Smoking Cessation at 6 and 12 Months after a Clinical Tobacco Smoking Cessation Intervention in Head and Neck Cancer Patients in Northern Ontario, Canada. Curr Oncol 2022; 29:1544-1558. [PMID: 35323330 PMCID: PMC8947430 DOI: 10.3390/curroncol29030130] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022] Open
Abstract
Smoking during cancer treatment is associated with reduced treatment response and cancer recurrence in patients with tobacco-related cancers. The purpose of this study was to examine smoking characteristics in head and neck cancer patients (n = 503) with a history of smoking and examine the impact of an intensive clinical tobacco intervention to patients who were currently smoking. All participants completed an interviewer-administered questionnaire at study enrollment which examined smoking behaviours, motivations to quit, and strategies used to cessate smoking. Follow-up assessments were completed at 6- and 12-months which monitored whether patients had quit smoking, remained cessated, or continued to smoke since study recruitment. For those who were currently smoking (n = 186, 37.0%), an intensive clinical tobacco intervention that utilized the 3A's-Ask, Advise, Arrange-and the Opt-Out approach was offered to assist with smoking cessation at their new patient visit and followed-up weekly during their head and neck radiation therapy for 7 weeks. At 6 months, 23.7% (n = 41) of those who were smoking successfully quit; 51.2% quit 'cold turkey' (defined as using no smoking cessation assistance, aids or pharmacotherapy to quit), while 34.9% used pharmacotherapy (varenicline (Champix)) to quit. On average, it took those who were smoking 1-5 attempts to quit, but once they quit they remained cessated for the duration of the study. Although the head and neck cancer patients in this study reported high levels of nicotine dependence, many were able to successfully cessate.
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Affiliation(s)
- Stacey A. Santi
- Health Sciences North Research Institute (HSNRI), Sudbury, ON P3E 5J1, Canada; (S.A.S.); (M.S.C.C.); (M.L.M.); (K.M.-B.)
| | - Michael S. C. Conlon
- Health Sciences North Research Institute (HSNRI), Sudbury, ON P3E 5J1, Canada; (S.A.S.); (M.S.C.C.); (M.L.M.); (K.M.-B.)
- School of Rural and Northern Health, Laurentian University, Sudbury, ON P3E 2C6, Canada
- Northern Ontario School of Medicine (NOSM), Sudbury, ON P3E 2C6, Canada;
| | - Margaret L. Meigs
- Health Sciences North Research Institute (HSNRI), Sudbury, ON P3E 5J1, Canada; (S.A.S.); (M.S.C.C.); (M.L.M.); (K.M.-B.)
| | - Stacey M. Davidson
- Northern Ontario School of Medicine (NOSM), Sudbury, ON P3E 2C6, Canada;
- Northeast Cancer Centre (NECC), Health Sciences North, Sudbury, ON P3E 5J1, Canada
| | - Kyle Mispel-Beyer
- Health Sciences North Research Institute (HSNRI), Sudbury, ON P3E 5J1, Canada; (S.A.S.); (M.S.C.C.); (M.L.M.); (K.M.-B.)
| | - Deborah P. Saunders
- Health Sciences North Research Institute (HSNRI), Sudbury, ON P3E 5J1, Canada; (S.A.S.); (M.S.C.C.); (M.L.M.); (K.M.-B.)
- Northern Ontario School of Medicine (NOSM), Sudbury, ON P3E 2C6, Canada;
- Northeast Cancer Centre (NECC), Health Sciences North, Sudbury, ON P3E 5J1, Canada
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10
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Katz DA, Mott SL, Utech JA, Bahlmann AC, Dukes KA, Seaman AT, Laux DE, Furqan M, Pollock ZJ, Vander Weg MW. Time to put it out - nurse-facilitated tobacco treatment in a comprehensive cancer center. Transl Behav Med 2021; 11:1726-1738. [PMID: 34347876 PMCID: PMC8529899 DOI: 10.1093/tbm/ibab073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Few cancer patients receive guideline-concordant care for treatment of tobacco dependence. The purpose of this pilot trial was to obtain preliminary estimates of effectiveness of an evidence-based practice intervention on the delivery of tobacco treatment and cessation outcomes in cancer patients. We conducted a pragmatic implementation trial with a before-after design in 119 current or recently quit adult smokers with cancer who met with a clinician at a single National Cancer Institute designated comprehensive cancer center (CCC) (n = 61 pre-implementation, n = 58 post-implementation). We used a multi-component strategy based on the Chronic Care Model to implement National Comprehensive Cancer Network (NCCN) guidelines for smoking cessation. Smoking cessation counseling during the index visit was assessed by exit interview and patients were interviewed by phone to assess cessation outcomes at 3-month follow-up. Performance of cessation counseling and 7-day point prevalence abstinence (PPA) were compared across the pre- and post-implementation periods using log-logistic regression, accounting for clustering by nursing staff. More patients had received assistance in quitting at the index visit during the post-implementation period compared to the pre-implementation period (30 vs. 10%, p < .01). At 3-month follow-up, 38 and 14% of participants had discussed smoking cessation medication with a CCC healthcare professional and 57 and 27% of participants had used pharmacotherapy, respectively (p < .01 for both comparisons). Seven-day PPA at 3-month follow-up was similar in both periods, however (14 vs. 12%, respectively). A multi-component tobacco treatment intervention increased the proportion of smokers who received assistance in quitting smoking during usual cancer care but did not improve cessation outcomes.
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Affiliation(s)
- David A Katz
- Department of Medicine, University of Iowa,
Iowa City, IA, USA
- Department of Epidemiology, University of Iowa,
Iowa City, IA, USA
| | - Sarah L Mott
- The Holden Comprehensive Cancer Center, University of Iowa Hospitals
& Clinics, Iowa City, IA, USA
| | - Jane A Utech
- The Holden Comprehensive Cancer Center, University of Iowa Hospitals
& Clinics, Iowa City, IA, USA
| | - Autumn C Bahlmann
- The Holden Comprehensive Cancer Center, University of Iowa Hospitals
& Clinics, Iowa City, IA, USA
| | | | - Aaron T Seaman
- Department of Medicine, University of Iowa,
Iowa City, IA, USA
- The Holden Comprehensive Cancer Center, University of Iowa Hospitals
& Clinics, Iowa City, IA, USA
- Department of Community and Behavioral Health, University of
Iowa, Iowa City, IA, USA
| | - Douglas E Laux
- Department of Medicine, University of Iowa,
Iowa City, IA, USA
- The Holden Comprehensive Cancer Center, University of Iowa Hospitals
& Clinics, Iowa City, IA, USA
| | - Muhammad Furqan
- Department of Medicine, University of Iowa,
Iowa City, IA, USA
- The Holden Comprehensive Cancer Center, University of Iowa Hospitals
& Clinics, Iowa City, IA, USA
| | - Zachary J Pollock
- The Holden Comprehensive Cancer Center, University of Iowa Hospitals
& Clinics, Iowa City, IA, USA
| | - Mark W Vander Weg
- Department of Medicine, University of Iowa,
Iowa City, IA, USA
- Department of Community and Behavioral Health, University of
Iowa, Iowa City, IA, USA
- Department of Psychological and Brain Sciences, University of
Iowa, Iowa City, IA, USA
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11
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Khodadadi AB, Carroll W, Lee EL, Hansen B, Scarinci IC. It Takes Two to Tango: Patients' and Providers' Perspectives in Tobacco Cessation and Head/Neck Cancer. Oncologist 2021; 26:761-770. [PMID: 34105215 DOI: 10.1002/onco.13856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 05/26/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Tobacco cessation among patients with head/neck cancer continues to be challenging despite evidence that cessation improves treatment outcomes. The purpose of this study was to understand barriers/facilitators to tobacco cessation among patients with head/neck cancer and health care providers and to obtain perspectives toward the development of a patient-centered tobacco cessation intervention. MATERIALS AND METHODS In-depth qualitative interviews with 10 health care providers and 21 patients with head/neck cancer (12 inpatients and 9 outpatients) who were current or former smokers. RESULTS Health was a common motivator to quit among patients. Although most patients indicated that their health care provider asked and advised them to quit, they were unaware of cessation resources. Suggestions for a tobacco cessation program included involvement of former smokers, health care provider involvement/counseling, supporting written materials, and incorporating follow-up and family support. Health care providers identified patients' anger/frustration associated with the disease, social/demographic issues, and poor quality of life as the three most frequent challenges in treating patients. Although all providers reported asking about tobacco use, 70% emphasized a lack of formal training in tobacco cessation and lack of time. Their suggestions for a cessation program included having a "quarterback" responsible for this component with support from the entire health care team and continuity between outpatient and inpatient services to promote cessation, prevent relapse, and highlight the importance of follow-up and social support. CONCLUSION There is great interest and need, both from patients and providers, for tobacco cessation services in the oncology setting tailored for patients with head/neck cancer in the context of cancer care. IMPLICATIONS FOR PRACTICE Although the combination of pharmacotherapy and cognitive-behavioral intervention is the standard evidence-based treatment for tobacco dependence, it must be adapted to meet the needs and wants of patients and providers to be effective. This study provides an in-depth examination of such needs among patients with head and neck cancer and providers in the context of cancer care. Providers and patients emphasized the need of having a trained health care provider dedicated to providing tobacco cessation through seamless integration between outpatient and inpatient services as well as follow-up with an emphasis on family involvement throughout the process.
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Affiliation(s)
| | - William Carroll
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Erica L Lee
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Barbara Hansen
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Isabel C Scarinci
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
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12
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D'Angelo H, Land SR, Mayne RG. Assessing Electronic Nicotine Delivery Systems Use at NCI-Designated Cancer Centers in the Cancer Moonshot-funded Cancer Center Cessation Initiative. Cancer Prev Res (Phila) 2021; 14:763-766. [PMID: 34127508 DOI: 10.1158/1940-6207.capr-21-0105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/14/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022]
Abstract
Assessing tobacco product use and delivering tobacco dependence treatment is an essential part of cancer care; however, little is known about electronic nicotine delivery systems (ENDS) or e-cigarette use assessment in cancer treatment settings. Given the importance of tailoring tobacco treatment, it is critical to understand how ENDS use is assessed in the electronic health record (EHR) in cancer care settings. Two questionnaires were completed by tobacco treatment program leads at 42 NCI-Designated Cancer Centers in the Cancer Center Cessation Initiative (January 1 to June 30 and July 1 to December 31, 2019). Items assessed how often smoking status and ENDS use were recorded in the EHR. An open-ended item recorded the text and response categories of each center's ENDS assessment question. All 42 centers assessed smoking status at both time periods. Twenty-five centers (59.5%) assessed ENDS use in the first half of 2019, increasing to 30 (71.4%) in the last half of 2019. By the end of 2019, 17 centers assessed smoking status at every patient visit while six assessed ENDS use at every visit. A checkbox/drop-down menu rather than scripted text was used at 30 centers (73.2%) for assessing smoking status and at 18 centers (42.9%) for assessing ENDS use. Our findings underscore the gap in systematic ENDS use screening in cancer treatment settings. Requiring ENDS use measures in the EHR as part of quality measures and providing scripted text scripts to providers may increase rates of ENDS use assessment at more cancer centers. PREVENTION RELEVANCE: This study identifies a gap in the systematic assessment of ENDS use among patients seen at 42 NCI-Designated cancer centers. Requiring the systematic assessment of both ENDS use and use of other tobacco products can inform evidence-based treatment of tobacco dependence and lead to improved cancer treatment outcomes.
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Affiliation(s)
- Heather D'Angelo
- Health Communications and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland.
| | - Stephanie R Land
- Health Communications and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland.,Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Rachel Grana Mayne
- Health Communications and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland.,Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
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13
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Chavarria EA, Christy SM, Simmons VN, Vadaparampil ST, Gwede CK, Meade CD. Learner Verification: A Methodology to Create Suitable Education Materials. Health Lit Res Pract 2021; 5:e49-e59. [PMID: 34251862 PMCID: PMC8075101 DOI: 10.3928/24748307-20210201-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Learner verification and revision (LV&R) is a research methodological approach to inform educational message design with the aim of producing suitable, actionable, and literacy appropriate messages to aid in awareness, adoption of healthy behaviors, and decision-making. It consists of a series of participatory steps that engage users throughout materials development, revision, and refinement. This approach is congruent with Healthy People 2030 communication objectives to improve access to information among diverse, multicultural, multilingual populations, and enhance health care quality toward health equity. Brief description of activity: To illustrate LV&R, we describe its use in three cancer education projects that produced targeted information about (1) inherited breast cancer among African Americans (brochure); (2) colorectal cancer screening among Latinos (photo novella and DVD); and (3) smoking-relapse prevention among patients receiving cancer treatment (video). We discuss rationale for its application in the three exemplars and extrapolate lessons learned from our experiences when using this approach. Implementation: A qualitative approach entailing individual or group-based discussions helped to examine the elements of learner verification (i.e., attraction, comprehension, self-efficacy, cultural acceptability, persuasion). The following steps are reported: (1) preparation of materials, interview guide, and recruitment; (2) interviewing of participants; and (3) evaluation of responses. Data were analyzed by use of a coding system that placed participant responses from each of the elements into data summary matrices. Findings informed revisions and refinement of materials. Results: LV&R was effectively applied across the three cancer education projects to enhance the suitability of the materials. As a result, the materials were improved by using clearer, more salient language to enhance comprehension and cultural acceptability, by integrating design elements such as prompts, headers, and stylistic edits to reduce text density, incorporating preferred colors and graphics to improve aesthetic appeal, and including actionable terms and words to bolster motivation and self-efficacy. Lessons learned: Results suggest that LV&R methodology can improve suitability of education materials through systematic, iterative steps that engage diverse, multicultural, multilingual populations. This approach is a critical participa-tory strategy toward health equity, and is appropriate in a variety of education, research, and clinical practice settings to improve health communications. [HLRP: Health Literacy Research and Practice. 2021;5(1):e49–e59.] Plain Language Summary: This article describes the use of a systematic approach called “learner verification” used for developing educational materials. This approach involves obtaining feedback from audience members to ensure that the information is understandable, attractive in design, motivating, and culturally relevant.
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Affiliation(s)
| | | | | | | | | | - Cathy D. Meade
- Address correspondence to Cathy D. Meade, PhD, RN, FAAN, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, MFC-EDU, Tampa, FL 33612;
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14
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Implementation of tobacco cessation services at a comprehensive cancer center: a qualitative study of oncology providers’ perceptions and practices. Support Care Cancer 2020; 29:2465-2474. [DOI: 10.1007/s00520-020-05749-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/04/2020] [Indexed: 12/27/2022]
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15
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Neil JM, Price SN, Friedman ER, Ponzani C, Ostroff JS, Muzikansky A, Park ER. Patient-Level Factors Associated with Oncology Provider-Delivered Brief Tobacco Treatment Among Recently Diagnosed Cancer Patients. Tob Use Insights 2020; 13:1179173X20949270. [PMID: 32874095 PMCID: PMC7436840 DOI: 10.1177/1179173x20949270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 05/31/2020] [Indexed: 12/25/2022] Open
Abstract
Background: A cancer diagnosis is seen as a “teachable moment” for patients to consider changing their behavioral risk factors, such as smoking. It also offers an opportunity for oncology providers to engage in a dialogue about how they can support patients changing their smoking behaviors. Brief, evidence-based tobacco cessation treatment delivered by oncology providers through the 5As (Ask, Advise, Assess, Assist Arrange) model is recommended, but provision to cancer patients remains suboptimal. Aim: Explore patient-level factors associated with 5As receipt among current smokers with a newly diagnosed cancer. Method: A total of 303 patients self-reported whether they received each of the 5As during their most recent oncology care visit. Multivariable regression analyses were conducted to identify patient-level factors associated with 5As receipt. Results: Oncology provider-delivered 5As rates ranged from 81.5% (Ask) to 30.7% (Arrange). 5As receipt was associated with: reporting lower illness-related stigma, diagnosis of a comorbid smoking-related disease, diagnosis of a smoking-related cancer, and diagnosis of a non-advanced cancer. Conclusion: Findings support previous literature in which smoking-related diagnoses were associated with greater receipt of 5As; however, disparities in the receipt of 5As existed for patients with more advanced cancer diagnoses and illness-related stigma. Inequities in the provision of quit assistance may further decrease treatment effectiveness and survival expectancy among certain patient populations. These findings are, therefore, important as they identify specific patient-level factors associated with lower 5As receipt among newly diagnosed cancer patients.
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Affiliation(s)
- J M Neil
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - S N Price
- University of Arizona, Tucson, AZ, USA
| | | | - C Ponzani
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - J S Ostroff
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - A Muzikansky
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - E R Park
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
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16
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Weiss Y, Bristow B, Karol DL, Fitch M, McAndrew A, Gibson L, Court A, Curle E, Di Prospero L. Exploring Tobacco Use and Smoking Cessation Best Practices From the Perspectives of Individuals With Lung Cancer and Health Care Professionals. J Med Imaging Radiat Sci 2020; 51:62-67. [PMID: 32007482 DOI: 10.1016/j.jmir.2019.11.139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 11/20/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Lung cancer patients who continue to smoke after diagnosis are at increased risk of treatment toxicity, residual/recurrent disease, future malignancies, and all-cause mortality. Guidelines including those from National Comprehensive Cancer Network and Cancer Care Ontario advocate for screening, counseling, and access to smoking cessation services for all cancer patients; however, barriers from both patient and health care professional (HCP) perspectives contribute to lack of implementation. OBJECTIVE The objective of this study was to identify the different perspectives among patients and HCPs in how the promotion of person-centred approaches may be used when offering smoking cessation services to patients who are receiving care within a regional cancer centre. METHODS Qualitative data were generated using various methods, including focus groups with HCPs and interviews with patients. In total, 16 HCPs participated in three focus groups: including nine radiation therapists, five registered nurses, one registered dietitian, and one physiotherapist. Of 55 patients accrued, 19 were interviewed. Both focus groups and interviews were audio recorded, and the recordings were transcribed verbatim. Transcripts were then analyzed using narrative thematic analysis to define and identify themes. RESULTS The identified themes were categorized into three topic areas: knowledge (eg, impact of smoking on illness and why they should not smoke); individual decision to quit (eg, motivators), and the social unacceptability of smoking (eg, the public perception of smoking over the last 40 years). HCP-identified themes included identification of smokers, triggers to start a conversation, approach, gaps and barriers to cessation, rationale for cessation, and judgment. Patient-identified themes included knowledge, individual decision to quit, and the social unacceptability of smoking. CONCLUSION Understanding patient and HCP perspectives on smoking cessation will help influence practice to ensure that patients are not judged, assumptions are not made, and individualized and person-centred care is provided. HCP awareness of these themes and the patient perspective may challenge assumptions and values.
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Affiliation(s)
- Yonatan Weiss
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Bonnie Bristow
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Therapy, Odette Cancer Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Margaret Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Alison McAndrew
- Aisling Discoveries Child and Family Centre, Toronto, Ontario, Canada
| | - Leslie Gibson
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Arlene Court
- Mississauga Halton Local Health Integration Network, Mississauga, Ontario, Canada
| | - Elaine Curle
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lisa Di Prospero
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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17
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Hoover DS, Spears CA, Vidrine DJ, Walker JL, Shih YCT, Wetter DW. Smoking Cessation Treatment Needs of Low SES Cervical Cancer Survivors. Am J Health Behav 2019; 43:606-620. [PMID: 31046890 PMCID: PMC6686858 DOI: 10.5993/ajhb.43.3.14] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: We investigated the treatment needs and preferences of low socioeconomic status cervical cancer survivors to inform the adaptation of a theoretically- and empirically-based Motivation and Problem-Solving approach to facilitate cessation in this at-risk population. Methods: Individual in-depth interviews were conducted with 12 female smokers with cervical cancer. Interviews were audio-recorded, transcribed, and analyzed using NVivo 10. Results: Most participants did not believe that smoking caused cervical cancer and attributed their diagnosis solely to human papillomavirus. They suggested that cessation treatment for cervical cancer survivors include psychoeducation about the impact of smoking on health and cancer and the benefits of quitting, pharmacotherapy, planning for quitting, strategies for coping with cravings/withdrawal, social support, real-time support, a nonjudgmental and understanding counselor, tailoring, and follow-up. They recommended that negativity/judgment and being told that "smoking is bad" not be included in treatment. Participants also suggested that treatment address stress management, issues specific to cervical cancer survivorship, and physical activity and healthy eating. Conclusions: Results highlight the unique treatment needs of low socioeconomic status smokers with cervical cancer and will inform the adaptation of an existing evidence-based inter- vention to encourage smoking cessation in this population.
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Charlesworth L, Hutton D, Hussain H. Therapeutic Radiographers' perceptions of the barriers and enablers to effective smoking cessation support. Radiography (Lond) 2019; 25:121-128. [PMID: 30955684 DOI: 10.1016/j.radi.2018.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 11/18/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Tobacco smoking during and post radiotherapy is associated with increased treatment toxicity and increased cancer related mortality. Routine delivery of smoking cessation advice is inconsistent in practice. This study identifies the key barriers and facilitators to the provision of effective smoking cessation conversations in radiotherapy practice. METHODS A baseline questionnaire (n = 43) was used to identify current practice, barriers and facilitators to smoking cessation in radiotherapy and to inform a topic guide for follow up focus groups (n = 5). Ethical approval was obtained through the 4 NHS trusts and the Health Research Authority. Focus group transcription was coded by two researchers. RESULTS Therapeutic Radiographers initiate health behaviour conversations with patients; there are a number of factors that facilitate the likelihood of a health behaviour conversation; indication that a patient smokes anatomical site and presence of acute effects. Key barriers to smoking cessation provision include; lack of training, limited knowledge, limitations as a result of poor clinical infrastructure, local culture and perceptions that patients do not prioritise smoking cessation during treatment. CONCLUSION Therapeutic Radiographers have the motivation to provide smoking cessation advice, however they require further training to develop knowledge and skills in relation to benefits of smoking cessation and cessation strategies. Therapeutic Radiographers also expect that patients will respond negatively to smoking cessation advice, and that this might be damaging to the therapeutic relationship. Departmental culture and trust infrastructure can also significantly inhibit the provision of smoking cessation in radiotherapy practice and further support to implement NICE guidance is required.
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Affiliation(s)
- L Charlesworth
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, S10 2BP, UK.
| | - D Hutton
- Transforming Cancer Care Project, The Clatterbridge Cancer Centre NHS FT, Wirral, CH63 4Jy, UK.
| | - H Hussain
- The Christie NHS Foundation Trust, Manchester, UK.
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19
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Reed SC, Walker R, Ziebell R, Rabin B, Nutt S, Chubak J, Nekhlyudov L. Cancer Survivors' Reported Discussions with Health Care Providers About Follow-Up Care and Receipt of Written Care Plans. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:1181-1188. [PMID: 28480500 DOI: 10.1007/s13187-017-1228-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Prior studies reveal gaps in cancer survivors' discussions with health care providers about follow-up care and receipt of care plans; however, whether survivorship care planning may vary by cancer type is not known. We surveyed 615 survivors of breast, colorectal, prostate, lung cancer, and melanoma enrolled in three health plans to examine cancer survivors' self-reported discussions of follow-up care, including the need for surveillance, late and long-term effects, emotional needs, and health behaviors. We assessed whether cancer survivors received a written treatment summary and post-treatment care instructions. Most (92%) survivors reported having a discussion about the need for surveillance; 75%, late and long-term effects; 69%, lifestyle and health behaviors; and 53%, emotional and social needs. Most (88%) reported receiving post-treatment care instructions and 47%, a treatment summary. While there was little difference among survivors' receipt of surveillance or health behavior recommendations by cancer type (p = 0.85 and p = 0.66, respectively), discussions of late and long-term effects occurred among 82% of prostate, 78% of breast, 73% of melanoma, 72% of colorectal, and 67% of lung survivors (p = 0.06). Approximately half of survivors reported discussions of emotional needs, with modest differences by cancer type (p = 0.08). Our findings indicate that most patient-provider discussions cover information on surveillance, with less emphasis on late and long-term effects, lifestyle and health behaviors, and substantially less focusing on emotional and social needs. No or modest differences in discussions occurred by cancer type. Whether tailoring information to individual cancer survivor needs is beneficial should be examined.
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Affiliation(s)
- Sarah C Reed
- Jane Addams College of Social Work, University of Illinois at Chicago, 1040 West Harrison Street, Chicago, IL, 60607-7134, USA.
| | - Rod Walker
- Kaiser Permanente Health Research Institute, Seattle, WA, USA
| | - Rebecca Ziebell
- Kaiser Permanente Health Research Institute, Seattle, WA, USA
| | - Borsika Rabin
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Stephanie Nutt
- Dell Medical School, University of Texas, Austin, TX, USA
| | - Jessica Chubak
- Kaiser Permanente Health Research Institute, Seattle, WA, USA
| | - Larissa Nekhlyudov
- Department of Population Medicine, Harvard Medical School and Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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20
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Price SN, Studts JL, Hamann HA. Tobacco Use Assessment and Treatment in Cancer Patients: A Scoping Review of Oncology Care Clinician Adherence to Clinical Practice Guidelines in the U.S. Oncologist 2018; 24:229-238. [PMID: 30446582 DOI: 10.1634/theoncologist.2018-0246] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 10/16/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Smoking after a cancer diagnosis negatively impacts health outcomes; smoking cessation improves symptoms, side effects, and overall prognosis. The Public Health Service and major oncology organizations have established guidelines for tobacco use treatment among cancer patients, including clinician assessment of tobacco use at each visit. Oncology care clinicians (OCCs) play important roles in this process (noted as the 5As: Asking about tobacco use, Advising users to quit, Assessing willingness to quit, Assisting in quit attempts, and Arranging follow-up contact). However, OCCs may not be using the "teachable moments" related to cancer diagnosis, treatment, and survivorship to provide cessation interventions. MATERIALS AND METHODS In this scoping literature review of articles from 2006 to 2017, we discuss (1) frequency and quality of OCCs' tobacco use assessments with cancer patients and survivors; (2) barriers to providing tobacco treatment for cancer patients; and (3) the efficacy and future of provider-level interventions to facilitate adherence to tobacco treatment guidelines. RESULTS OCCs are not adequately addressing smoking cessation with their patients. The reviewed studies indicate that although >75% assess tobacco use during an intake visit and >60% typically advise patients to quit, a substantially lower percentage recommend or arrange smoking cessation treatment or follow-up after a quit attempt. Less than 30% of OCCs report adequate training in cessation interventions. CONCLUSION Intervention trials focused on provider- and system-level change are needed to promote integration of evidence-based tobacco treatment into the oncology setting. Attention should be given to the barriers faced by OCCs when targeting interventions for the oncologic context. IMPLICATIONS FOR PRACTICE This article reviews the existing literature on the gap between best and current practices for tobacco use assessment and treatment in the oncologic context. It also identifies clinician- and system-level barriers that should be addressed in order to lessen this gap and provides suggestions that could be applied across different oncology practice settings to connect patients with tobacco use treatments that may improve overall survival and quality of life.
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Affiliation(s)
- Sarah N Price
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Jamie L Studts
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Heidi A Hamann
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
- Department of Family and Community Medicine, University of Arizona, Tucson, Arizona, USA
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21
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Martínez Ú, Brandon TH, Sutton SK, Simmons VN. Associations between the smoking-relatedness of a cancer type, cessation attitudes and beliefs, and future abstinence among recent quitters. Psychooncology 2018; 27:2104-2110. [PMID: 29785718 DOI: 10.1002/pon.4774] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 04/10/2018] [Accepted: 05/14/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Smoking after a diagnosis of cancer can negatively impact treatment outcomes and quality of life. It is important that patients quit smoking and remain abstinent regardless of cancer type. Some cancer types (eg, lung) have stronger links to smoking as a cause than do others (eg, colorectal). The aims of this study were to (1) assess associations between smoking-relatedness of the cancer type with beliefs and attitudes concerning smoking abstinence (eg, confidence, self-efficacy), and (2) assess these variables as predictors of future abstinence. METHODS In this secondary analysis, cancer patients (N = 357) who quit smoking within the previous 90 days were assigned a code of 3, 2, or 1 according to the cancer type's level of smoking-relatedness: Very related (n = 134, thoracic and head and neck), Somewhat related (n = 93, acute myeloid leukemia, bladder, cervix, colorectal, esophageal, kidney, liver, pancreas, and stomach), and Unlikely related (n = 137, all other cancer types). RESULTS Smoking-relatedness was positively associated with plan to stay smoke-free, maximum confidence in being smoke-free in 6 months, higher abstinence self-efficacy, and lower expected difficulty in staying smoke-free. Each of the 4 beliefs and attitude variables predicted abstinence 2 months later. Smoking-relatedness also predicted abstinence in a univariate model, but not in a multivariable model with the belief and attitude variables. Using backwards stepwise procedures, the final model included plan to stay smoke-free, confidence in being smoke-free, and abstinence self-efficacy. CONCLUSION These results are consistent with our conceptualization of cessation motivation differing by smoking-relatedness of the cancer type and predicting future abstinence.
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Affiliation(s)
- Úrsula Martínez
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Thomas H Brandon
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA.,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Steven K Sutton
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA.,Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Vani N Simmons
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA.,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA
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22
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Abstract
Healthcare providers often do not have the time to counsel patients on how to quit smoking. Consequently, little emphasis is placed on this pursuit, and no behavioral counseling is done. Using medications approved by the U.S. Food and Drug Administration in combination with behavioral counseling has been shown to be effective in smoking cessation programs. Oncology nurses, and advanced practice nurses in particular, can play a significant role in helping patients to quit smoking. This article details how one oncology clinical nurse specialist created a smoking cessation program at her institution.
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23
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Trout S, Goldstein AO, Marks L, Ripley-Moffitt C. Treating Tobacco Use in Patients with Incurable Malignancies: Should We Even Start the Conversation? J Palliat Med 2018; 21:746-750. [PMID: 29733246 PMCID: PMC6425924 DOI: 10.1089/jpm.2017.0304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Clinical practice guidelines recommend that all medical providers address tobacco use with patients, as the long-term health benefits of becoming tobacco free are well documented. What happens, though, when a patient has an incurable malignancy and, therefore, will not reap the long-term benefits? Clinical Consideration: Our case study encourages providers to consider the relevance of tobacco use treatment for those with incurable diseases. DISCUSSION Although long-term benefits will not provide realistic motivation, other equally important rewards (e.g., decreased shortness of breath), a sense of accomplishment shared by patients and family, and the ability to exert control over a behavior can be equally motivating for some patients.
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Affiliation(s)
- Susan Trout
- Department of Family Medicine, University of North Carolina , Chapel Hill, North Carolina
| | - Adam O Goldstein
- Department of Family Medicine, University of North Carolina , Chapel Hill, North Carolina
| | - Lawrence Marks
- Department of Family Medicine, University of North Carolina , Chapel Hill, North Carolina
| | - Carol Ripley-Moffitt
- Department of Family Medicine, University of North Carolina , Chapel Hill, North Carolina
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24
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Day FL, Sherwood E, Chen TY, Barbouttis M, Varlow M, Martin J, Weber M, Sitas F, Paul C. Oncologist provision of smoking cessation support: A national survey of Australian medical and radiation oncologists. Asia Pac J Clin Oncol 2018; 14:431-438. [PMID: 29706029 DOI: 10.1111/ajco.12876] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 03/07/2018] [Indexed: 11/27/2022]
Abstract
AIM Continued smoking in patients diagnosed with cancer affects treatment outcomes and overall survival. With national surveys of Australian medical oncologists (MO) and radiation oncologists (RO) we sought to determine current clinical practices, preferences and barriers in providing patient smoking cessation support. METHODS Oncologist members of the Medical Oncology Group of Australia (n = 452) and Trans-Tasman Radiation Oncology Group (n = 230) were invited to participate in a multiple choice survey exploring smoking cessation practices and beliefs. RESULTS The survey response rate was 43%. At first consultations more than 90% of MO and RO regularly asked patients if they smoke or use tobacco products, closely followed by documentation of duration of smoking history and current level of consumption. Less common was asking the patient if they intended to quit (MO 63%, RO 53%) and advising cessation (MO 70%, RO 72%). Less than 50% of oncologists regularly asked about current smoking in follow-up consultations. Although a range of referral options for smoking cessation care were used by oncologists, only 2% of MO and 3% of RO actively managed the patients' smoking cessation themselves and this was the least preferred option. The majority believed they require more training in cessation interventions (67% MO, 57% RO) and cited multiple additional barriers to providing cessation care. CONCLUSIONS Oncologists strongly prefer smoking cessation interventions to be managed by other health workers. A collaborative approach with other health professionals is needed to aid the provision of comprehensive smoking cessation care tailored to patients with cancer.
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Affiliation(s)
- Fiona L Day
- Department of Medical Oncology, Calvary Mater Newcastle, Waratah, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Emma Sherwood
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Tina Y Chen
- Cancer Institute NSW, Eveleigh, NSW, Australia
| | | | | | - Jarad Martin
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW, Australia
| | - Marianne Weber
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia.,School of Public Health, University of Sydney, Camperdown, NSW, Australia
| | - Freddy Sitas
- Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia.,School of Public Health and Community Medicine, University of NSW, Kensington, NSW, Australia
| | - Christine Paul
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Priority Research Centre for Cancer Research, Innovation and Translation, University of Newcastle, Callaghan, NSW, Australia
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25
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Meltzer LR, Meade CD, Diaz DB, Carrington MS, Brandon TH, Jacobsen PB, McCaffrey JC, Haura EB, Simmons VN. Development of a Targeted Smoking Relapse-Prevention Intervention for Cancer Patients. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:440-447. [PMID: 27476432 PMCID: PMC5288399 DOI: 10.1007/s13187-016-1089-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We describe the series of iterative steps used to develop a smoking relapse-prevention intervention customized to the needs of cancer patients. Informed by relevant literature and a series of preliminary studies, an educational tool (DVD) was developed to target the unique smoking relapse risk factors among cancer patients. Learner verification interviews were conducted with 10 cancer patients who recently quit smoking to elicit feedback and inform the development of the DVD. The DVD was then refined using iterative processes and feedback from the learner verification interviews. Major changes focused on visual appeal, and the inclusion of additional testimonials and graphics to increase comprehension of key points and further emphasize the message that the patient is in control of their ability to maintain their smoking abstinence. Together, these steps resulted in the creation of a DVD titled Surviving Smokefree®, which represents the first smoking relapse-prevention intervention for cancer patients. If found effective, the Surviving Smokefree® DVD is an easily disseminable and low-cost portable intervention which can assist cancer patients in maintaining smoking abstinence.
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Affiliation(s)
- Lauren R Meltzer
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, 4115 E Fowler Ave, Tampa, FL, 33617, USA
| | - Cathy D Meade
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, 4115 E Fowler Ave, Tampa, FL, 33617, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Department of Nursing, University of South Florida, Tampa, FL, USA
| | - Diana B Diaz
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, 4115 E Fowler Ave, Tampa, FL, 33617, USA
| | - Monica S Carrington
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, 4115 E Fowler Ave, Tampa, FL, 33617, USA
| | - Thomas H Brandon
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, 4115 E Fowler Ave, Tampa, FL, 33617, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Paul B Jacobsen
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, 4115 E Fowler Ave, Tampa, FL, 33617, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Department of Nursing, University of South Florida, Tampa, FL, USA
| | - Judith C McCaffrey
- Department of Otolaryngology, University of South Florida, Tampa, FL, USA
- Department of Otolaryngology - Head and Neck Surgery, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Eric B Haura
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Vani N Simmons
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, 4115 E Fowler Ave, Tampa, FL, 33617, USA.
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA.
- Department of Nursing, University of South Florida, Tampa, FL, USA.
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
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26
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Micaux Obol C, Armuand GM, Rodriguez-Wallberg KA, Ahlgren J, Ljungman P, Wettergren L, Lampic C. Oncologists and hematologists' perceptions of fertility-related communication - a nationwide survey. Acta Oncol 2017; 56:1103-1110. [PMID: 28379723 DOI: 10.1080/0284186x.2017.1310394] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Despite the negative impacts of several cancer treatments on fertility, many patients do not recall having fertility-related discussions with their physicians. This study was conducted to identify those factors related to physicians' discussing the treatment impacts on fertility with cancer patients of reproductive age. MATERIAL AND METHODS In this nationwide survey of cancer care physicians (n = 329, response rate 55%), oncologists and hematologists (mainly) completed a questionnaire on practice behavior, barriers, attitudes and confidence in knowledge regarding treatment-related fertility risks. Logistic regression analyses were conducted to identify factors associated with not routinely discussing fertility issues with patients. RESULTS Most of the physicians agreed that they were responsible for discussing fertility issues with patients of reproductive age (91%), but approximately 30% did not do so regularly. Those factors decreasing the likelihood of discussion were: patient already had children (female/male OR 3.0/6.9), high workload (OR 3.3/4.8), seeing <5 female/male patients of reproductive age weekly (OR 3.2/3.4) and access to a reproduction clinic (OR 5.2/4.2). CONCLUSIONS Most Swedish oncologists and hematologists regularly discuss impact of treatment on fertility with their patients. Those factors having a negative impact on fertility discussions may guide targeted organizational and educational efforts to further improve fertility-related communication in cancer care.
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Affiliation(s)
- C. Micaux Obol
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
| | - G. M. Armuand
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - K. A. Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Reproductive Medicine Karolinska, Karolinska University Hospital, Stockholm, Sweden
| | - J. Ahlgren
- Department of Oncology, University of Örebro, Örebro, Sweden
| | - P. Ljungman
- Departments of Allogeneic Stem Cell Transplantation and Hematology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Division of Hematology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - L. Wettergren
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
| | - C. Lampic
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
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27
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Wells M, Aitchison P, Harris F, Ozakinci G, Radley A, Bauld L, Entwistle V, Munro A, Haw S, Culbard B, Williams B. Barriers and facilitators to smoking cessation in a cancer context: A qualitative study of patient, family and professional views. BMC Cancer 2017; 17:348. [PMID: 28526000 PMCID: PMC5438552 DOI: 10.1186/s12885-017-3344-z] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 05/11/2017] [Indexed: 01/23/2023] Open
Abstract
Background Continued smoking after cancer adversely affects quality of life and survival, but one fifth of cancer survivors still smoke. Despite its demands, cancer presents an opportunity for positive behaviour change. Smoking often occurs in social groups, therefore interventions which target families and individuals may be more successful. This qualitative study explored patients, family members and health professionals’ views and experiences of smoking and smoking cessation after cancer, in order to inform future interventions. Methods In-depth qualitative interviews (n = 67) with 29 patients, 14 family members and 24 health professionals. Data were analysed using the ‘Framework’ method. Results Few patients and family members had used National Health Service (NHS) smoking cessation services and more than half still smoked. Most recalled little ‘smoking-related’ discussion with clinicians but were receptive to talking openly. Clinicians revealed several barriers to discussion. Participants’ continued smoking was explained by the stress of diagnosis; desire to maintain personal control; and lack of connection between smoking, cancer and health. Conclusions A range of barriers to smoking cessation exist for patients and family members. These are insufficiently assessed and considered by clinicians. Interventions must be more effectively integrated into routine practice.
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Affiliation(s)
- Mary Wells
- NMAHP Research Unit, University of Stirling, Scion House, Stirling, FK9 4HN, UK.
| | - Patricia Aitchison
- NMAHP Research Unit, University of Stirling, Scion House, Stirling, FK9 4HN, UK
| | - Fiona Harris
- NMAHP Research Unit, University of Stirling, Scion House, Stirling, FK9 4HN, UK
| | - Gozde Ozakinci
- School of Medicine, University of St Andrews, St Andrews, KY16 9TF, UK
| | - Andrew Radley
- NHS Tayside, Public Health Directorate, Kings Cross Hospital, Dundee, DD3 8EA, UK
| | - Linda Bauld
- Insitute of Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, UK
| | - Vikki Entwistle
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Alastair Munro
- School of Medicine, University of St Andrews, St Andrews, KY16 9TF, UK
| | - Sally Haw
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, UK
| | - Bill Culbard
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, UK
| | - Brian Williams
- School of Health and Social Care, Edinburgh Napier University, 9 Sighthill Court, Edinburgh, EH11 4BN, UK
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28
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Petersen AB, Meyer B, Sachs BL, Bialous SA, Cataldo JK. Preparing nurses to intervene in the tobacco epidemic: Developing a model for faculty development and curriculum redesign. Nurse Educ Pract 2017; 25:29-35. [PMID: 28463761 DOI: 10.1016/j.nepr.2017.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 07/11/2016] [Accepted: 04/07/2017] [Indexed: 10/19/2022]
Abstract
As the largest group of health professionals, nurses have a tremendous potential to help curb the tobacco epidemic. However, studies conducted across a range of global settings continue to indicate that both practicing nurses and nursing student have limited knowledge, skills and confidence needed to implement evidence-based tobacco cessation interventions. A contributing factor is the limited inclusion of tobacco control content in nursing curricula. Additionally, there is limited understanding of nurse educators' knowledge and perceptions about teaching tobacco dependence content. This paper presents the Loma Linda University School of Nursing's concurrent experience with both faculty development and curriculum redesign in the area of tobacco dependence prevention and treatment. An internal survey was administered at baseline and at 2-year follow-up to assess faculty's knowledge, perceptions and practices related to teaching tobacco dependence content and skills (n = 42). Faculty and curriculum development strategies and resources utilized, evaluation findings and subsequent lessons learned are described. The findings have implications for nursing programs seeking to enhance their curricula and commitment to ensuring that their graduates are prepared to provide evidence-based tobacco cessation interventions with each patient they encounter.
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Affiliation(s)
- Anne Berit Petersen
- Loma Linda University, School of Nursing, 11262 Campus St., West Hall, Loma Linda, CA 92350, USA; Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366, San Francisco, CA 94143, USA.
| | - Bonnie Meyer
- Loma Linda University, School of Nursing, 11262 Campus St., West Hall, Loma Linda, CA 92350, USA.
| | - Bonnie L Sachs
- Palo Alto Center for Pulmonary Disease Prevention, 145 North California Avenue, Palo Alto, CA 94301-3911, USA.
| | - Stella A Bialous
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366, San Francisco, CA 94143, USA; University of California, San Francisco, School of Nursing, 2 Koret Way, San Francisco, CA 94143, USA.
| | - Janine K Cataldo
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366, San Francisco, CA 94143, USA; University of California, San Francisco, School of Nursing, 2 Koret Way, San Francisco, CA 94143, USA.
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29
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Conlon K, Pattinson L, Hutton D. Attitudes of oncology healthcare practitioners towards smoking cessation: A systematic review of the facilitators, barriers and recommendations for delivery of advice and support to cancer patients. Radiography (Lond) 2017; 23:256-263. [PMID: 28687295 DOI: 10.1016/j.radi.2017.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/09/2017] [Accepted: 03/12/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES A systematic review of the literature was conducted. The review was conducted using a search of the literature for all years up to October 2016. Statements that identified facilitators, barriers or recommendations surrounding smoking cessation delivery were extracted and analogous statements aggregated to enable thematic analysis. After searching multiple databases and the application of exclusion and inclusion criteria, a total of 19 acceptable studies were identified. KEY FINDINGS Delivery of cessation by oncology professionals was impacted by their own knowledge and views, their perception of the benefits to patient health and by the workplace procedures within their institution. CONCLUSION Oncology practitioners worldwide face similar issues in delivering smoking cessation advice. By improving training programs that address the attitudes and beliefs which facilitate or block delivery of smoking cessation and by implementing systemic changes within cancer centres, delivery of smoking cessation should be enabled.
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Affiliation(s)
- K Conlon
- Sheffield Hallam University, Sheffield, UK
| | | | - D Hutton
- Transforming Cancer Care, The Clatterbridge Cancer Centre NHS FT, Wirral, UK
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30
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Mackereth P, Finchett C, Holt M. Smoke-free hospital site conversations: how nurses can initiate change. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2016; 25:1176-1180. [PMID: 27882792 DOI: 10.12968/bjon.2016.25.21.1176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Smoking tobacco continues to be the world's most preventable cause of death and disability with over six trillion cigarettes sold each year. Patients, visitors and health professionals who smoke on hospital sites present a challenge to the effectiveness of public health messages. Health professionals who ignore 'No smoking' hospital/clinic signage, and avoid smoking-cessation activity, help to sustain the perception that smoking is tolerated. Case studies, with a focus on lung cancer and chronic obstructive pulmonary disease (COPD), are used to illustrate how nurses can 'seed' the idea of hospitals becoming smoke-free, provide brief interventions and support patients, carers and colleagues to make that change.
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Affiliation(s)
- Peter Mackereth
- Tobacco Control Lead Nurse, The Christie NHS Foundation Trust, Manchester
| | | | - Melody Holt
- Community Engagement Manager, Roy Castle Lung Cancer Foundation, Liverpool
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31
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Fang CY, Heckman CJ. Informational and Support Needs of Patients with Head and Neck Cancer: Current Status and Emerging Issues. CANCERS OF THE HEAD & NECK 2016; 1. [PMID: 28670482 PMCID: PMC5488795 DOI: 10.1186/s41199-016-0017-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The objective of this article is to review and summarize the extant literature on head and neck cancer (HNC) patients’ informational needs and to characterize emerging issues in this patient population in order to define priorities for future research. HNC patients may undergo challenging treatment regimens and experience treatment-related alterations in primary daily functions such as speech and eating. These changes often persist following treatment and may lead to significant deficits in quality of life and interpersonal relations. Despite empirical evidence demonstrating that receipt of adequate information and support is predictive of improved outcomes post-treatment, relatively limited attention has been paid to the informational and support needs of HNC patients. This review focuses primarily on three topic domains: (1) managing treatment-related side effects; (2) addressing alcohol and tobacco dependence; and (3) informational needs in the areas of human papillomavirus (HPV) and clinical trials. While there is increasing awareness of the rehabilitation and survivorship needs in this patient population, patients note that the impact of treatment on social activities and interactions is under-discussed and of key concern. In addition, there is a significant gap in addressing communication and informational needs of caregivers and family members who are integral for promoting healthy behaviors and self-care post-treatment. Greater integration of programs that address tobacco or alcohol dependency within a comprehensive treatment and support plan may increase patient motivation to seek help and enhance patient success in maintaining long-term abstinence. Finally, emerging patient-provider communication needs, particularly in the context of decision making about clinical trials or surrounding an HPV-related diagnosis, have been noted among both patients and healthcare providers. Future research on the development of novel programs that offer feasible and acceptable methods for addressing unmet informational and support needs is warranted and may yield benefit for improving patient-reported outcomes.
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Affiliation(s)
- Carolyn Y Fang
- Fox Chase Cancer Center, 333 Cottman Ave., Philadelphia, PA
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Díaz DB, Brandon TH, Sutton SK, Meltzer LR, Hoehn HJ, Meade CD, Jacobsen PB, McCaffrey JC, Haura EB, Lin HY, Simmons VN. Smoking relapse-prevention intervention for cancer patients: Study design and baseline data from the surviving SmokeFree randomized controlled trial. Contemp Clin Trials 2016; 50:84-9. [PMID: 27468664 DOI: 10.1016/j.cct.2016.07.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/15/2016] [Accepted: 07/17/2016] [Indexed: 11/29/2022]
Abstract
Continued smoking after a cancer diagnosis contributes to several negative health outcomes. Although many cancer patients attempt to quit smoking, high smoking relapse rates have been observed. This highlights the need for a targeted, evidence-based smoking-relapse prevention intervention. The design, method, and baseline characteristics of a randomized controlled trial assessing the efficacy of a self-help smoking-relapse prevention intervention are presented. Cancer patients who had recently quit smoking were randomized to one of two conditions. The Usual Care (UC) group received the institution's standard of care. The smoking relapse-prevention intervention (SRP) group received standard of care, plus 8 relapse-prevention booklets mailed over a 3month period, and a targeted educational DVD developed specifically for cancer patients. Four hundred and fourteen participants were enrolled and completed a baseline survey. Primary outcomes will be self-reported smoking status at 6 and 12-months after baseline. Biochemical verification of smoking status was completed for a subsample. If found to be efficacious, this low-cost intervention could be easily disseminated with significant potential for reducing the risk of negative cancer outcomes associated with continued smoking.
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Affiliation(s)
- Diana B Díaz
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States.
| | - Thomas H Brandon
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, United States.
| | - Steven K Sutton
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, United States.
| | - Lauren R Meltzer
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States.
| | - Hannah J Hoehn
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States.
| | - Cathy D Meade
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, United States.
| | - Paul B Jacobsen
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, United States.
| | - Judith C McCaffrey
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, United States
| | - Eric B Haura
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, United States.
| | - Hui-Yi Lin
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States.
| | - Vani N Simmons
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, United States.
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Park ER, Ostroff JS, Perez GK, Hyland KA, Rigotti NA, Borderud S, Regan S, Muzikansky A, Friedman ER, Levy DE, Holland S, Eusebio J, Peterson L, Rabin J, Miller-Sobel J, Gonzalez I, Malloy L, O'Brien M, de León-Sanchez S, Whitlock CW. Integrating tobacco treatment into cancer care: Study protocol for a randomized controlled comparative effectiveness trial. Contemp Clin Trials 2016; 50:54-65. [PMID: 27444428 DOI: 10.1016/j.cct.2016.07.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/14/2016] [Accepted: 07/17/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite the well-established risks of persistent smoking, 10-30% of cancer patients continue to smoke after diagnosis. Evidence-based tobacco treatment has yet to be integrated into routine oncology care. This paper describes the protocol, manualized treatment, evaluation plan, and overall study design of comparing the effectiveness and cost of two treatments across two major cancer centers. METHODS/DESIGN A two-arm, two-site randomized controlled comparative effectiveness trial is testing the hypothesis that an Intensive Treatment (IT) intervention is more effective than a Standard Treatment (ST) intervention in helping recently diagnosed cancer patients quit smoking. Both interventions include 4 weekly counseling sessions and FDA-approved smoking cessation medication advice. The IT includes an additional 4 biweekly and 3 monthly booster sessions as well as dispensal of the recommended FDA-approved smoking cessation medication at no cost. The trial is enrolling patients with suspected or newly diagnosed cancer who have smoked a cigarette in the past 30days. Participants are randomly assigned to receive the ST or IT condition. Tobacco cessation outcomes are assessed at 3 and 6months. The primary study outcome is 7-day point prevalence biochemically-validated tobacco abstinence. Secondary study outcomes include the incremental cost-effectiveness of the IT vs. ST. DISCUSSION This trial will answer key questions about delivering tobacco treatment interventions to newly diagnosed cancer patients. If found to be efficacious and cost-effective, this treatment will serve as a model to be integrated into oncology care settings nation-wide, as we strive to improve treatment outcomes and quality of life for cancer patients.
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Affiliation(s)
- Elyse R Park
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, United States; Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, United States; Cancer Outcomes Research Program, Massachusetts General Hospital, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, MA, United States; Department of Medicine, Harvard Medical School, Boston, MA, United States.
| | - Jamie S Ostroff
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
| | - Giselle K Perez
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, United States; Cancer Outcomes Research Program, Massachusetts General Hospital, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.
| | - Kelly A Hyland
- H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, United States.
| | - Nancy A Rigotti
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, United States; Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, United States; Department of Medicine, Harvard Medical School, Boston, MA, United States.
| | - Sarah Borderud
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
| | - Susan Regan
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, United States.
| | - Alona Muzikansky
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, United States.
| | - Emily R Friedman
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, United States; Cancer Outcomes Research Program, Massachusetts General Hospital, Boston, MA, United States.
| | - Douglas E Levy
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, United States.
| | - Susan Holland
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
| | - Justin Eusebio
- Cancer Outcomes Research Program, Massachusetts General Hospital, Boston, MA, United States.
| | - Lisa Peterson
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
| | - Julia Rabin
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, United States; Cancer Outcomes Research Program, Massachusetts General Hospital, Boston, MA, United States.
| | - Jacob Miller-Sobel
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
| | - Irina Gonzalez
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.
| | - Laura Malloy
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, MA, United States.
| | - Maureen O'Brien
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
| | - Suhana de León-Sanchez
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
| | - C Will Whitlock
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
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Counseling Is Effective for Smoking Cessation in Head and Neck Cancer Patients-A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2016; 74:1687-94. [PMID: 26973223 DOI: 10.1016/j.joms.2016.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 02/02/2016] [Accepted: 02/07/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this systematic review was to describe the efficacy of smoking cessation counseling and the resulting quit rate in patients with head and neck cancer. MATERIALS AND METHODS A systematic literature search was conducted in the PubMed, Embase, and Cochrane databases. Predictor variables were smoking cessation counseling and smoking cessation interventions. The outcome was smoking cessation. Data collection and quality assessment were performed independently by 2 of the authors. Selected publications were assessed for potential risk of bias, and the level of evidence was evaluated using National Health and Medical Research Council guidelines. Review Manager 5.3 was used to conduct the meta-analysis. RESULTS Eight studies involving 1,239 patients were included (3 randomized controlled trials, 3 cohorts, and 2 case series). Smoking cessation was achieved considerably more often in patients who received smoking cessation counseling compared with those who received usual care. CONCLUSIONS This review shows that counseling supplemented with nicotine replacement therapy increases the possibility for smoking cessation in patients with head and neck cancer.
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Warren GW, Ward KD. Integration of tobacco cessation services into multidisciplinary lung cancer care: rationale, state of the art, and future directions. Transl Lung Cancer Res 2015; 4:339-52. [PMID: 26380175 DOI: 10.3978/j.issn.2218-6751.2015.07.15] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 07/16/2015] [Indexed: 12/31/2022]
Abstract
Tobacco use is the largest risk factor for lung cancer and many lung cancer patients still smoke at the time of diagnosis. Although clinical practice guidelines recommend that all patients receive evidence-based tobacco treatment, implementation of these services in oncology practices is inconsistent and inadequate. Multidisciplinary lung cancer treatment programs offer an ideal environment to optimally deliver effective smoking cessation services. This article reviews best practice recommendations and current status of tobacco treatment for oncology patients, and provides recommendations to optimize delivery of tobacco treatment in multidisciplinary practice.
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Affiliation(s)
- Graham W Warren
- 1 Department of Cell and Molecular Pharmacology and Experimental Therapeutics and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA ; 2 Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Kenneth D Ward
- 1 Department of Cell and Molecular Pharmacology and Experimental Therapeutics and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA ; 2 Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
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Steinberger E, Kollmeier M, McBride S, Novak C, Pei X, Zelefsky MJ. Cigarette smoking during external beam radiation therapy for prostate cancer is associated with an increased risk of prostate cancer-specific mortality and treatment-related toxicity. BJU Int 2015; 116:596-603. [PMID: 25345838 DOI: 10.1111/bju.12969] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate whether a history of smoking or smoking during therapy after external beam radiotherapy (EBRT) for clinically localised prostate cancer is associated with increased treatment-related toxicity or disease progression. PATIENTS AND METHODS Of 2358 patients receiving EBRT for prostate cancer between 1988 and 2005, 2156 had chart-recorded smoking histories. Patients were classified as 'never smokers', 'current smokers', 'former smokers', and 'current smoking unknown'. Variables considered included quantity of tobacco use in pack-years, duration of smoking, and, for former smokers, how long before initiation of RT the patient quit smoking, when available. The median EBRT dose was 8100 Gy and the median follow-up was 95 months. Toxicity was graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events. RESULTS Current smoking significantly increased the risks of both prostate-specific antigen relapse [hazard ratio (HR) 1.4, P = 0.02] and distant metastases (HR 2.37, P < 0.001), as well as prostate cancer-specific death (HR 2.25, P < 0.001). Multivariate analysis showed that smoking was also associated with increased risk of EBRT-related genitourinary toxicities (current smoker, HR 1.8, P = 0.02; former smoker, HR 1.45, P = 0.01). Smoking did not increase gastrointestinal toxicity. CONCLUSIONS Current smokers with prostate cancer are at increased risk of biochemical recurrence, distant metastasis, and prostate cancer-related mortality after definitive RT to the prostate. Current and former smokers, regardless of duration and quantity of exposure, are at an increased risk of long-term genitourinary toxicity after EBRT. Oncologists should encourage patients to participate in smoking-cessation programmes before therapy to potentially lower their risk of relapsing disease and post-treatment toxicities.
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Affiliation(s)
- Emily Steinberger
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marisa Kollmeier
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sean McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Caroline Novak
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Xin Pei
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Abstract
The increasing popularity and availability of electronic cigarettes (i.e., e-cigarettes) in many countries have promoted debate among health professionals as to what to recommend to their patients who might be struggling to stop smoking or asking about e-cigarettes. In the absence of evidence-based guidelines for using e-cigarettes for smoking cessation, some health professionals have urged caution about recommending them due to the limited evidence of their safety and efficacy, while others have argued that e-cigarettes are obviously a better alternative to continued cigarette smoking and should be encouraged. The leadership of the International Association for the Study of Lung Cancer asked the Tobacco Control and Smoking Cessation Committee to formulate a statement on the use of e-cigarettes by cancer patients to help guide clinical practice. Below is this statement, which we will update periodically as new evidence becomes available.
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Bloom EL, Oliver JA, Sutton SK, Brandon TH, Jacobsen PB, Simmons VN. Post-operative smoking status in lung and head and neck cancer patients: association with depressive symptomatology, pain, and fatigue. Psychooncology 2014; 24:1012-9. [PMID: 25257853 DOI: 10.1002/pon.3682] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 07/24/2014] [Accepted: 08/21/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE An estimated 35-50% of lung and head and neck cancer patients are smoking at diagnosis; most try to quit; however, a substantial proportion resumes smoking. As cancer treatments improve, attention to the effects of continued smoking on quality of life in the survivorship period is increasing. The current study examines if smoking abstinence following surgical treatment is associated with better quality of life. METHODS Participants were 134 patients with head and neck or lung cancer who received surgical treatment. Smoking status and indices of quality of life (depressive symptoms, fatigue, and pain) were assessed at the time of surgery (baseline) and at 2, 4, 6, and 12 months post-surgery. Analyses were performed using a generalized estimating equations approach. A series of models examined the correlation between smoking status and post-surgery quality of life while adjusting for demographics, clinical variables, and baseline smoking status and quality of life. RESULTS Continuous post-surgery abstinence was associated with lower levels of depressive symptoms and fatigue; however, the relationship with fatigue became nonsignificant after adjusting for baseline fatigue and income. There was no significant relationship observed between smoking status and pain. CONCLUSIONS Findings add to a growing literature showing that smoking cessation is not associated with detrimental effects on quality of life and may have beneficial effects, particularly with regard to depressive symptoms. Such information can be used to motivate smoking cessation and continued abstinence among cancer patients and increase provider comfort in recommending cessation.
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Affiliation(s)
- Erika Litvin Bloom
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Butler Hospital, Providence, RI, USA
| | - Jason A Oliver
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Steven K Sutton
- Department of Psychology, University of South Florida, Tampa, FL, USA.,Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center, Tampa, FL, USA.,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Thomas H Brandon
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA.,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Paul B Jacobsen
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA.,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Vani Nath Simmons
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA.,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
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Westmaas JL, Alcaraz KI, Berg CJ, Stein KD. Prevalence and correlates of smoking and cessation-related behavior among survivors of ten cancers: findings from a nationwide survey nine years after diagnosis. Cancer Epidemiol Biomarkers Prev 2014; 23:1783-92. [PMID: 25100826 DOI: 10.1158/1055-9965.epi-14-0046] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Smoking is detrimental to recovery and survival from cancer, but many cancer survivors continue to smoke. Information is lacking on smoking patterns of survivors many years after diagnosis and correlates of smoking status and patterns, likelihood of quitting, and intentions to quit. METHODS Cross-sectional analyses were conducted among survivors of 10 cancers recruited by stratified random sampling from cancer registries in a nationwide, longitudinal, quality-of-life study (n = 2,938). RESULTS Approximately 9 years after diagnosis, 9.3% of all survivors were current (past 30-day) smokers. Smoking prevalence was highest among survivors of bladder (17.2%), lung (14.9%), and ovarian (11.6%) cancers. Most current smokers (83%) smoked daily, averaging 14.7 cigarettes per day (cpd). Forty percent of daily smokers smoked more than 15 cpd. Nondaily smokers smoked a mean of 10.9 days in the last 30 days and averaged 5.7 cpd on smoking days. Current smoking was associated with younger age, lower education and income, and greater alcohol consumption. Quitting after diagnosis was associated with having a smoking-related cancer. Roughly, a third of current smokers intended to quit, 40% within the next month. The odds of intending to quit were lower if survivors were married, older, or smoked more. CONCLUSIONS This population-based study indicated that smoking can persist long after initial diagnosis and at high levels and identified characteristics associated with quitting and intentions to quit. IMPACT Findings can be used to identify survivors most at risk for continued smoking and to inform tailoring of cessation treatments for survivors.
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Affiliation(s)
- J Lee Westmaas
- Behavioral Research Center (BRC), American Cancer Society, Atlanta, Georgia.
| | | | - Carla J Berg
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Kevin D Stein
- Behavioral Research Center (BRC), American Cancer Society, Atlanta, Georgia
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Smoking cessation dialogue and the complementary therapist: reluctance to engage? Complement Ther Clin Pract 2014; 20:181-7. [PMID: 25168007 DOI: 10.1016/j.ctcp.2014.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 07/23/2014] [Accepted: 07/29/2014] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Our aim was to explore the experiences and views of complementary therapists (CT) regarding smoking cessation (SC) support within the oncology setting. METHODS Two oncology sites participated in the North West of England. Three focus groups were conducted (n = 19) with resulting transcripts thematically analysed. Demographic data was collected via a short questionnaire. RESULTS Reasons were given for reluctance to engage in SC support, these included; fear of comprising the therapeutic relationship, patient's poor motivation and/or those living with life limiting disease. Nicotine Replacement Therapy (NRT) advice was regarded as a 'medical' activity. There was evidence of smoker-related stigmatisation. CONCLUSION This study provided insights in how complementary therapists view a potential SC role. Research is needed to determine whether the findings are common to other areas of CT practice. Further training in SC support is suggested for those working in oncology settings.
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Toll BA, Rojewski AM, Duncan LR, Latimer-Cheung AE, Fucito LM, Boyer JL, O'Malley SS, Salovey P, Herbst RS. "Quitting smoking will benefit your health": the evolution of clinician messaging to encourage tobacco cessation. Clin Cancer Res 2014; 20:301-9. [PMID: 24436474 DOI: 10.1158/1078-0432.ccr-13-2261] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Illnesses that are caused by smoking remain as the world's leading cause of preventable death. Smoking and tobacco use constitute approximately 30% of all cancer-related deaths and nearly 90% of lung cancer-related deaths. Thus, improving smoking cessation interventions is crucial to reduce tobacco use and assist in minimizing the burden of cancer and other diseases in the United States. This review focuses on the existing research on framed messages to promote smoking cessation. Consistent with the tenets of prospect theory and recent meta-analysis, gain-framed messages emphasizing the benefits of quitting seem to be preferable when working with adult patients who smoke tobacco products. The evidence also suggests that moderators of treatment should guide framed statements made to patients. Meta-analyses have provided consistent moderators of treatment such as need for cognition, but future studies should further define the specific framed interventions that would be most helpful for subgroups of smokers. In conclusion, instead of using loss-framed statements like "Smoking will harm your health by causing problems like lung and other cancers, heart disease, and stroke," as a general rule, physicians should use gain-framed statements like "Quitting smoking will benefit your health by preventing problems like lung and other cancers, heart disease, and stroke."
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Affiliation(s)
- Benjamin A Toll
- Authors' Affiliations: Yale University School of Medicine; Yale Cancer Center; Smilow Cancer Hospital at Yale-New Haven; Yale University, New Haven, Connecticut; McGill University, Montreal; and Queen's University, Kingston, Canada
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Morgan G, Schnoll RA, Alfano CM, Evans SE, Goldstein A, Ostroff J, Park ER, Sarna L, Cox LS. National cancer institute conference on treating tobacco dependence at cancer centers. J Oncol Pract 2013; 7:178-82. [PMID: 21886500 DOI: 10.1200/jop.2010.000175] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2010] [Indexed: 11/20/2022] Open
Abstract
The National Cancer Institute cancer centers possess the credibility to help smokers quit. With the greater life expectancies forecast for patients with cancer, addressing smoking at cancer centers has taken on greater importance.
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Affiliation(s)
- Glen Morgan
- Tobacco Control Research Branch and Office of Cancer Survivorship, National Cancer Institute; Bethesda, MD; Department of Psychiatry, University of Pennsylvania, Philadelphia, PA; Department of Family Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC; Behavioral Science Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Psychiatry and Health Policy, Harvard Medical School, Boston, MA; School of Nursing, University of California, Los Angeles, Los Angeles, CA; Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
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Simmons VN, Haura EB, Brandon TH. Oncology healthcare providers’ pivotal role in smoking cessation and relapse prevention. Lung Cancer Manag 2013. [DOI: 10.2217/lmt.13.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Vani Nath Simmons
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Department of Health Outcomes & Behavior, H Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Eric B Haura
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
- Department of Thoracic Oncology, H Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Thomas H Brandon
- Department of Health Outcomes & Behavior, H Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
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Anderson AS, Caswell S, Wells M, Steele RJC. Obesity and lifestyle advice in colorectal cancer survivors - how well are clinicians prepared? Colorectal Dis 2013; 15:949-57. [PMID: 23480570 DOI: 10.1111/codi.12203] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 12/21/2012] [Indexed: 12/13/2022]
Abstract
AIM This study aimed to assess colorectal clinicians' knowledge and understanding about the risks and benefits of weight management, to document current practice and to identify perceived barriers to providing lifestyle advice to colorectal cancer survivors. METHOD Questionnaires were sent to 768 clinicians (doctors and nurses) working in colorectal cancer, identified from professional databases. These data were complemented by in-depth interviews exploring opportunities for and barriers to giving lifestyle advice. RESULTS A total of 323 replies were received (42% response rate) and 20 respondents completed in-depth interviews. Half (52%) reported that they were familiar with guidance for lifestyle advice for cancer survivors. Most (77%) thought reducing weight was important for improving the health of those who were overweight and 75% thought it appropriate to offer lifestyle advice to people with body mass index over 30 kg/m(2) . Half (50%) reported that weight reduction was an important service priority for normal clinical practice. Half (50%) of respondents said that they would value additional training in this area. Interview data revealed that current practice is influenced by the lack of evidence for the impact of weight management and a belief that 'weight gain is good and weight loss bad' in the cancer setting. Patient sensitivity, time available, role constraints and lack of skills in weight management were also factors. CONCLUSION There is an awareness of the importance of weight management amongst colorectal cancer clinicians and some indication of advice being provided. However, current perceptions, knowledge and skills suggest scope for further training.
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Simmons VN, Litvin EB, Jacobsen PB, Patel RD, McCaffrey JC, Oliver JA, Sutton SK, Brandon TH. Predictors of smoking relapse in patients with thoracic cancer or head and neck cancer. Cancer 2012; 119:1420-7. [PMID: 23280005 DOI: 10.1002/cncr.27880] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 08/21/2012] [Accepted: 10/04/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cancer patients who continue smoking are at increased risk for adverse outcomes including reduced treatment efficacy and poorer survival rates. Many patients spontaneously quit smoking after diagnosis; however, relapse is understudied. The goal of this study was to evaluate smoking-related, affective, cognitive, and physical variables as predictors of smoking after surgical treatment among patients with lung cancer and head and neck cancer. METHODS A longitudinal study was conducted with 154 patients (57% male) who recently quit smoking. Predictor variables were measured at baseline (ie, time of surgery); smoking behavior was assessed at 2, 4, 6, and 12 months after surgery. Analyses of 7-day point prevalence were performed using a Generalized Estimating Equations approach. RESULTS Relapse rates varied significantly depending on presurgery smoking status. At 12 months after surgery, 60% of patients who smoked during the week prior to surgery had resumed smoking versus only 13% who were abstinent prior to surgery. Smoking rates among both groups were relatively stable across the 4 follow-ups. For patients smoking before surgery (N = 101), predictors of smoking relapse included lower quitting self-efficacy, higher depression proneness, and greater fears about cancer recurrence. For patients abstinent before surgery (N = 53), higher perceived difficulty quitting and lower cancer-related risk perceptions predicted smoking relapse. CONCLUSIONS Efforts to encourage early cessation at diagnosis, and increased smoking relapse-prevention efforts in the acute period following surgery, may promote long-term abstinence. Several modifiable variables are identified to target in future smoking relapse-prevention interventions for cancer patients.
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Affiliation(s)
- Vani Nath Simmons
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL 33647, USA.
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Shuman AG, Fins JJ, Prince ME. Improving end-of-life care for head and neck cancer patients. Expert Rev Anticancer Ther 2012; 12:335-43. [PMID: 22369325 DOI: 10.1586/era.12.6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite improvements in the treatment of head and neck cancer, many patients still succumb to their disease. A litany of medical, psychosocial and ethical challenges arise in managing the end-of-life experiences within this patient population. In this article, we attempt to review existing data about the end-of-life experiences of this cohort, extrapolate relevant data from other cancer patients, and suggest the most promising avenues for additional research and practice improvement for terminal head and neck cancer patients. Clinical decision-making for patients dying of head and neck cancer requires proactive consideration of quality of life, functionality, symptom control and other patient-centered objectives, and frequently benefits from palliative care team involvement. Additional research aimed toward optimizing the end of life experience of head and neck cancer patients and their families is greatly needed.
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Affiliation(s)
- Andrew G Shuman
- Division of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
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Land SR. Methodologic Barriers to Addressing Critical Questions About Tobacco and Cancer Prognosis. J Clin Oncol 2012; 30:2030-2. [DOI: 10.1200/jco.2012.41.7402] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Stephanie R. Land
- National Cancer Institute, National Institutes of Health, Bethesda, MD
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Simmons VN, Litvin EB, Unrod M, Brandon TH. Oncology healthcare providers' implementation of the 5A's model of brief intervention for smoking cessation: patients' perceptions. PATIENT EDUCATION AND COUNSELING 2012; 86:414-9. [PMID: 21784598 PMCID: PMC3222746 DOI: 10.1016/j.pec.2011.06.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 05/20/2011] [Accepted: 06/23/2011] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Health care providers (HCPs) can play an important role in promoting smoking cessation and preventing relapse. Public Health Service guidelines recommend the "5A's" model of brief intervention. The goal of the current study was to examine cancer patients' perceptions of 5A's model implementation by their oncology HCPs. METHODS This study included 81 thoracic and 87 head and neck cancer patients at a large NCI-designated comprehensive cancer center. Patients completed questionnaires assessing perceptions of their oncology HCPs' implementation of the 5A's model of brief intervention. RESULTS Results indicate partial implementation of the 5A's model. The majority of patients reported that their providers had asked about smoking and advised them to quit, however; only half reported that their interest in quitting had been assessed, and few reported assistance in quitting or follow-up. Delivery of the 5A's was greater among patients who requested cessation advice from their HCPs. CONCLUSION The current findings suggest a need to increase adherence to the 5A's in the oncology setting. PRACTICAL IMPLICATIONS Efforts to increase smoking cessation treatment provision by HCPs may improve the rate of cessation among cancer patients, and ultimately translate into better long-term cancer treatment outcomes.
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Affiliation(s)
- Vani Nath Simmons
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33647, USA.
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Weaver KE, Danhauer SC, Tooze JA, Blackstock AW, Spangler J, Thomas L, Sutfin EL. Smoking cessation counseling beliefs and behaviors of outpatient oncology providers. Oncologist 2012; 17:455-62. [PMID: 22334454 DOI: 10.1634/theoncologist.2011-0350] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Many cancer patients continue to smoke after diagnosis, increasing their risk for treatment complications, reduced treatment efficacy, secondary cancers, and reduced survival. Outpatient oncology providers may not be using the "teachable moment" of cancer diagnosis to provide smoking cessation assistance. PROVIDERS AND METHODS: Physicians and midlevel providers (n = 74) who provide outpatient oncology services completed an online survey regarding smoking cessation counseling behaviors, beliefs, and perceived barriers. Outpatient medical records for 120 breast, lung, head and neck, colon, prostate, and acute leukemia cancer patients were reviewed to assess current smoking cessation assessment and intervention documentation practices. RESULTS Providers reported commonly assessing smoking in new patients (82.4% frequently or always), but rates declined at subsequent visits for both current smokers and recent quitters. Rates of advising patients to quit smoking were also high (86.5% frequently or always), but <30% of providers reported frequently or always providing intervention to smoking patients (e.g., nicotine replacement therapy or other medications, self-help materials, and/or referrals). Only 30% of providers reported that they frequently or always followed up with patients to assess progress with quitting. Few providers (18.1%) reported high levels of confidence in their ability to counsel smoking patients. Patients' lack of motivation was identified as the most important barrier to smoking cessation. CONCLUSIONS Although beliefs about providing cessation services to smoking patients were generally positive, few providers reported commonly providing interventions beyond advice to quit. Additional training and clinic-based interventions may improve adherence to tobacco cessation practice guidelines in the outpatient oncology setting.
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Affiliation(s)
- Kathryn E Weaver
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Wells Fargo Building, 14th Floor, Winston-Salem, North Carolina 27157, USA.
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Park ER, Japuntich SJ, Rigotti NA, Traeger L, He Y, Wallace RB, Malin JL, Zallen JP, Keating NL. A snapshot of smokers after lung and colorectal cancer diagnosis. Cancer 2012; 118:3153-64. [PMID: 22271645 DOI: 10.1002/cncr.26545] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 05/02/2011] [Accepted: 05/09/2011] [Indexed: 11/12/2022]
Abstract
BACKGROUND Continued smoking after a cancer diagnosis may adversely affect treatment effectiveness, subsequent cancer risk, and survival. The prevalence of continued smoking after cancer diagnosis is understudied. METHODS In the multi-regional Cancer Care Outcomes Research and Surveillance cohort (lung cancer [N = 2456], colorectal cancer [N = 3063]), the authors examined smoking rates at diagnosis and 5 months after diagnosis and also study factors associated with continued smoking. RESULTS Overall, 90.2% of patients with lung cancer and 54.8% of patients with colorectal cancer reported ever smoking. At diagnosis, 38.7% of patients with lung cancer and 13.7% of patients with colorectal cancer were smoking; whereas, 5 months after diagnosis, 14.2% of patients with lung cancer and 9.0% of patients with colorectal cancer were smoking. Factors that were associated independently with continued smoking among patients with nonmetastatic lung cancer were coverage by Medicare, other public/unspecified insurance, not receiving chemotherapy, not undergoing surgery, prior cardiovascular disease, lower body mass index, lower emotional support, and higher daily ever-smoking rates (all P < .05). Factors that were associated independently with continued smoking among patients with nonmetastatic colorectal cancer were male sex, high school education, being uninsured, not undergoing surgery, and higher daily ever-smoking rates (all P < .05). CONCLUSIONS After diagnosis, a substantial minority of patients with lung and colorectal cancers continued smoking. Patients with lung cancer had higher rates of smoking at diagnosis and after diagnosis; whereas patients with colorectal cancer were less likely to quit smoking after diagnosis. Factors that were associated with continued smoking differed between lung and colorectal cancer patients. Future smoking-cessation efforts should examine differences by cancer type, particularly when comparing cancers for which smoking is a well established risk factor versus cancers for which it is not.
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Affiliation(s)
- Elyse R Park
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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