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Kruse GR, Joyce A, Yu L, Park ER, Neil J, Chang Y, Rigotti NA. A pilot adaptive trial of text messages, mailed nicotine replacement therapy, and telephone coaching among primary care patients who smoke. J Subst Use Addict Treat 2023; 145:208930. [PMID: 36880910 PMCID: PMC10016234 DOI: 10.1016/j.josat.2022.208930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 07/01/2022] [Accepted: 10/31/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Sequential multiple assignment randomized trials (SMART) inform the design of adaptive treatment interventions. We tested the feasibility of a SMART to deliver a stepped-care intervention among primary care patients who smoked daily. METHODS In a 12-week pilot SMART (NCT04020718), we tested the feasibility of recruiting and retaining (>80 %) participants to an adaptive intervention starting with cessation text messages (SMS). The study randomly assigned participants (R1) to assessment of quit status, the tailoring variable, after either 4 or 8 weeks of SMS. The study offered continued SMS alone to those reporting abstinence. Those reporting smoking were randomized (R2) to SMS + mailed NRT or SMS + NRT + brief telephone coaching. RESULTS During Jan-March and July-Aug 2020, we enrolled 35 patients (>18 years) from a primary care network in Massachusetts. Two (6 %) of 31 participants reported seven-day point prevalence abstinence at their tailoring variable assessment. The 29 participants who continued to smoke at 4 or 8 weeks were randomized (R2) to SMS + NRT (n = 16) or SMS + NRT + coaching (n = 13). Thirty of 35 participants (86 %) completed 12-weeks; 13 % (2/15) of those in 4-week group and 27 % (4/15) of those in 8-week group had CO < 6 ppm at 12-weeks (p = 0.65). Among 29 participants in R2, one was lost to follow-up, 19 % (3/16) of the SMS + NRT group had CO < 6 ppm vs. 17 % (2/12) of SMS + NRT + coaching (p = 1.00). Treatment satisfaction was high (93 %, 28 of 30 who completed 12-weeks). CONCLUSIONS A SMART exploring a stepped-care adaptive intervention combining SMS, NRT, and coaching for primary care patients was feasible. Retention and satisfaction were high and quit rates were promising.
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Affiliation(s)
- G R Kruse
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America.
| | - A Joyce
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, United States of America
| | - L Yu
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, United States of America
| | - E R Park
- Tobacco Research and Treatment Center, Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America; Department of Psychiatry, Massachusetts General Hospital, United States of America; Health Policy Research Center, Massachusetts General Hospital, United States of America
| | - J Neil
- Tobacco Research and Treatment Center, Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America; Health Policy Research Center, Massachusetts General Hospital, United States of America; Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, United States of America
| | - Y Chang
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America
| | - N A Rigotti
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America; Health Policy Research Center, Massachusetts General Hospital, United States of America
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Styklunas GM, Shahid NN, Park ER, Haberer JE, Rigotti NA, Howard SE, Kruse GR. A qualitative analysis of nicotine replacement therapy uptake, consistent use, and persistence among primary care patients who smoke. Drug Alcohol Depend Rep 2021; 2:100018. [PMID: 36845902 PMCID: PMC9948942 DOI: 10.1016/j.dadr.2021.100018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
•Adherence can be broken into three processes: uptake, consistent use, and persistence.•Barriers and facilitators to NRT use vary over the three adherence processes.•Information gaps and negative stories about NRT are common barriers to adherence.•NRT adherence may be improved by addressing patient knowledge and concerns.
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Affiliation(s)
- GM Styklunas
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States,Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, United States,Tufts University School of Medicine, Boston, MA, United States,Corresponding author at: Internal Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, Massachusetts 02114, United States.
| | - NN Shahid
- Department of Psychology, University of Miami, Miami, FL, United States
| | - ER Park
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, United States,Harvard Medical School, Boston, MA, United States,Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - JE Haberer
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States,Center for Global Health, Massachusetts General Hospital, Boston, MA, United States,Harvard Medical School, Boston, MA, United States
| | - NA Rigotti
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States,Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, United States,Harvard Medical School, Boston, MA, United States,Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - SE Howard
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - GR Kruse
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States,Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, United States,Harvard Medical School, Boston, MA, United States
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Nipp RD, El-Jawahri A, Fishbein JN, Gallagher ER, Stagl JM, Park ER, Jackson VA, Pirl WF, Greer JA, Temel JS. Factors associated with depression and anxiety symptoms in family caregivers of patients with incurable cancer. Ann Oncol 2016; 27:1607-12. [PMID: 27177859 DOI: 10.1093/annonc/mdw205] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/09/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Family caregivers (FCs) are critically important for patients with cancer, yet they may experience psychological distress related to caregiving demands. We sought to describe rates of depression and anxiety in FCs of patients with incurable cancer and identify factors associated with these symptoms to determine those at greatest risk for psychological distress. PATIENTS AND METHODS We performed a cross-sectional analysis of baseline data from a randomized trial of early palliative care. We assessed depression and anxiety using the Hospital Anxiety and Depression Scale in patients within 8 weeks of diagnosis of incurable lung or gastrointestinal cancer and their FCs. We also assessed patients' quality of life (Functional Assessment of Cancer Therapy-General), coping strategies (Brief COPE), and their report of the primary goal of their cancer treatment. We used linear regression with purposeful selection of covariates to identify factors associated with FC depression and anxiety symptoms. RESULTS We enrolled 78.6% (n = 275) of potentially eligible FCs. The majority were female (69.1%) and married to the patient (66.2%). While the proportion of FCs and patients reporting depression did not differ (16.4% versus 21.5%, P = 0.13), FCs were more likely to report anxiety compared with patients (42.2% versus 28.4%, P < 0.001). Patients' use of acceptance coping was associated with lower FC depression (B = -0.42, P < 0.001), while emotional support coping was associated with higher FC depression (B = 0.69, P = 0.001) and lower FC anxiety (B = -0.70, P < 0.001). Patient report that their primary goal of their treatment was to 'cure my cancer' was associated with higher FC depression (B = 0.72, P = 0.03). CONCLUSIONS Patients with incurable cancer and their FCs report high levels of depression and anxiety symptoms. We demonstrated that patients' coping strategies and prognostic understanding were associated with FC depression and anxiety symptoms, underscoring the importance of targeting these risk factors when seeking to address the psychological distress experienced by FCs.
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Affiliation(s)
- R D Nipp
- Department of Medicine, Division of Hematology and Oncology
| | - A El-Jawahri
- Department of Medicine, Division of Hematology and Oncology
| | | | - E R Gallagher
- Department of Medicine, Division of Hematology and Oncology
| | | | | | - V A Jackson
- Department of Medicine, Division of Palliative Care, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | | | | | - J S Temel
- Department of Medicine, Division of Hematology and Oncology
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Lennes IT, Temel JS, Greer JA, Jacobson JO, Park ER, Jackson VA, Gallagher ER, Bemis H, Pirl WF. ASCO Quality Oncology Practice Initiative (QOPI) quality measures for smoking cessation and survival in metastatic NSCLC. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.6074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Swetter SM, Pollitt RA, Brooks DR, Johnson TM, Park ER, Geller AC. Efficacy of physician and self skin-examination practices for early melanoma detection. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.9037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Moy B, Park ER, Feibelmann S, Chiang S, Weissman JS. Barriers to repeat mammography screening: Perspectives of minority women. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
BACKGROUND Little is known about the influence of personal and practice-level factors on physicians' dietary counseling practices. METHODS Primary care physicians (n = 130) were surveyed regarding the frequency that they "ask" patients about their diet, "assess" patients' reasons for and against dietary changes, "advise" patients to eat less fat and more fiber, "assist" patients in changing their diet, and "arrange" a follow-up contact to discuss their diet. In addition, physicians were asked their personal dietary practices, counseling confidence, practice demographics, and medical specialty. RESULTS Physicians who (a) reported consistently avoiding dietary fat, (b) were more confident in their diet counseling abilities, and (c) were sole owners of their practice were more likely to counsel than physicians who were employees or part owners of the practice. For example, physicians who reported consistently avoiding dietary fat (50.7% of physicians) were 3.2 (95% CI: 1.3-7.9) times more likely to "ask" their patients about their diet and 3.5 (95% CI: 1.5-8.6) times likely to "advise" their patients to eat less fat and more fiber. CONCLUSIONS Given the strong and consistent effects of a physician's dietary pattern on their counseling practices, future studies should examine the impact of modifying a physician's diet on their patients' dietary behavior.
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Affiliation(s)
- C N Sciamanna
- Department of Community Medicine, Brown Medical School, The Miriam Hospital, Providence, RI 02903, USA.
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Affiliation(s)
- E R Park
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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