Background While quitting smoking dramatically decreases overall mortality, general practitioners (GPs) are less likely to prescribe medications for smoking cessation than other cardiovascular risk factors. Guidelines recommend providers first assess patients’ “readiness” to quit, an “opt-in” strategy, but only a minority of tobacco users are ready to quit on a given day. An “opt-out” strategy offering treatment as the default choice increased quit attempts in hospital and with pregnant women, but has not been tested in primary care. We will assess the efficacy of training GPs to offer treatment as the default choice using an encounter decision aid with current smokers seen in primary care. Methods This is a pragmatic cluster-randomized controlled superiority trial with block randomization at the GP level in private practice in French-speaking Switzerland. GPs will be blinded to the arm allocation. The intervention is a half-day training course teaching an ‘opt-out’ approach to smoking cessation using an encounter decision aid (paper or electronic). GPs in the enhanced usual care group receives a brief refresher training about smoking cessation without changing their behaviour. GPs in both arms will recruit 23 patients each prior to routine primary care visits. The primary outcome is the effect of consulting a GP who received the intervention on the 7-day, point prevalence, smoking abstinence 6 months after the baseline appointment. Secondary outcomes include continuous abstinence; number of quit attempts; use of smoking cessation aids; patient-perceived involvement in discussions; and changes in GP behaviour. Patient outcomes will be collected using paper and telephone questionnaires. Assuming 15% drop-out, recruiting 46 GPs with 23 patients each will give us 80% power to detect an increase in smoking cessation from 4% (control) to 10.5% (intervention), with an alpha < 0.05. Discussion GP visits are an opportunity to administer proven smoking cessation treatments. We hypothesize GPs offering smoking cessation treatment as the default choice using an encounter decision aid will increase the number of patients who quit. This study could significantly change our approach to smoking cessation in primary care. Default choices and the electronic decision aid are low-cost, easily diffusible interventions. Trial registration ClinicalTrials.gov Identifier: NCT04868474, First Posted May 3, 2021, Last Update Posted October 6, 2021.
Background Smoking cessation is an essential part of preventing and reducing the risk of smoking-associated morbidity and mortality. However, there is often little time to discuss smoking cessation in primary care. Decision aids (DAs) designed for clinic visits (encounter DAs) need to be clear, short, and concise to optimize therapeutic education, increase interaction, and improve the therapeutic alliance. Such a DA for smoking cessation could potentially improve counseling and increase the use of pharmacological treatments. Objective We aimed to collect feedback on an electronic encounter DA that facilitates physician-patient interaction and shared decision-making for smoking cessation in primary care. Methods We developed an electronic, encounter DA (howtoquit.ch) from a paper version created by our team in 2017 following user-centered design principles. The DA is a 1-page interactive website presenting and comparing medications for tobacco cessation and electronic cigarettes. Each smoking cessation medication has a drop down menu that presents additional information, a video demonstration, and prescribing information for physicians. To test the DA, we submitted a questionnaire to approximately 20 general practitioner residents of an academic general medicine department, 5 general practitioners, and 6 experts in the field of smoking cessation. The questionnaire consisted of 4 multiple-choice and 2 free-text questions assessing the usability or acceptability of the DA, the acquisition of new knowledge for practitioners, the perceived utility in supporting shared decision-making, perceived strengths and weaknesses, and whether the participants would recommend the tool to other clinicians. Results In all, 6 residents, 3 general practitioners in private practice, and 2 tobacco cessation experts completed the questionnaire (N=11), with 4 additional experts providing open-text feedback. On the 11 questionnaires, the DA was rated as practical and intuitive (mean 4.6/5), and providers felt it supported shared decision-making (mean 4.4/5), as comparisons were readily possible. Inclusion of explanatory videos was seen as a bonus. Several changes were suggested, like grouping together similar medications and adding a landing page to briefly explain the site. Changes were implemented according to end-user comments. Conclusions The overall assessment of the encounter DA by a group of physicians and experts was positive. The ultimate objective is to have the tool deployed and easily accessible for all to use.
Les outils d'aide à la décision (AD) soutiennent les patient-e-s dans leurs choix médicaux en majorant leurs connaissances et en clarifiant leurs valeurs et préférences, ce qui leur permet de s'impliquer dans le processus décisionnel. Les AD existent en tant que supports physiques (papier, DVD) ou informatiques. Ils peuvent être utilisés par les patient-e-s avant/après la consultation ou avec le-la professionnel-le de santé durant la consultation. Unisanté a créé un AD présentant les aides à l'arrêt du tabac durant la consultation. Une étude locale a montré que l'usage de celui-ci a été jugé simple et utile par les médecins. L'utilisation d'AD dans les addictions à d'autres substances, renforcée par des entretiens de décision partagée, montre un effet favorable sur l'implication des patient-e-s et sur l'adhésion thérapeutique. Decision aids for addictions: the example of smoking cessationDecision aids (DAs) help patients participate in healthcare decisions by improving knowledge and clarifying values and preferences, thus favoring a more active role in the decision process. DAs exist as a physical support (paper, DVD, audio) or computerized formats.They can be used independently by patients before and after consultations, or with a health professional during consultations. Unisanté has created a DA for use during consultations presenting available smoking cessation aids (www.howtoquit.ch). A local study showed that the DA is considered easy to use and useful by the doctors interviewed. The use of DAs in addictions to other substances, in conjunction with shared decision making, shows a favourable effect on the involvement of patients in their health and therapeutic adherence.
BACKGROUND Smoking cessation is an essential part of preventing and reducing risk of smoking associated morbidity and mortality. However, there is often little time to discuss smoking cessation in primary care. Encounter decision aids, short, patient-facing decision aids used during clinic visits, optimize therapeutic education and increase interaction and the therapeutic alliance. Such a decision aid for smoking cessation could potentially improve counselling and increase the use of pharmacological treatments. OBJECTIVE We aimed to develop and test an electronic encounter decision aid (DA) that facilitates physician-patient interaction and shared decision making for smoking cessation in primary care. METHODS We developed a DA (howtoquit.ch) adapted from a paper version developed by our team in 2017 following user-centered design principles. The DA is a one page interactive website presenting and comparing medications for tobacco cessation and electronic cigarettes. Each smoking cessation medication has a drop down menu that presents additional information, a video demonstration, and prescribing information for physicians. To test the DA, a questionnaire was submitted to general practitioner residents of an academic general medicine department, five general practitioners, and five experts in the field of smoking cessation. The questionnaire consisted of 4 multiple-choice and 2 free text questions assessing the usability/acceptability of the DA, the acquisition of new knowledge for practitioners, the perceived utility in supporting shared decision making and patients' choices, perceived strengths and weaknesses and if they would recommend the tool to other clinicians. RESULTS Six residents, 3 general practitioners in private practice, and 2 tobacco cessation experts completed the questionnaire (n=11), and 4 additional experts provided open-text feedback. On the 11 questionnaires, the DA was rated as practical and intuitive (mean 4.6/5) and supported shared decision making (mean 4.4/5), as comparisons were readily possible. Inclusion of explanatory videos was seen as a bonus. Several changes were suggested like grouping together similar medications and adding a landing page to briefly explain the site. Changes were implemented according to the end users comments. CONCLUSIONS The overall assessment of the DA by a group of physicians and experts was positive. The ultimate objective is to have the tool deployed and easily accessible for all to use.
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