Background A cancer diagnosis can catalyze motivation to quit smoking. Tobacco treatment trials offer cessation resources but have low accrual rates. Digital outreach may improve accrual, but knowledge of how best to recruit smokers with recent diagnoses is limited. Objective This study aims to identify the message frames that were most effective in promoting intent to talk to a physician about participating in a tobacco treatment trial for smokers recently diagnosed with cancer. Methods From February to April 2019, current smokers diagnosed within the past 24 months were recruited from a national web-based panel for a multimethod pilot randomized trial (N=99). Participants were randomized to a 2×3 plus control factorial design that tested 3 unique message frames: proximal versus distal threats of smoking, costs of continued smoking versus benefits of quitting, and gains of participating versus losses of not participating in a tobacco treatment trial. The primary outcome was intent to talk to a physician about participating in a tobacco treatment trial. In phase 1, the main effect within each message factor level was examined using ANOVA and compared with the control condition. Other message evaluation and effectiveness measures were collected and explored in a multivariable model predicting intent to talk to a physician. In phase 2, open-text evaluations of the messages were analyzed using natural language processing software (Leximancer) to generate a thematic concept map and Linguistic Inquiry Word Count to identify and compare the prevalence of linguistic markers among message factors. Results Of the 99 participants, 76 (77%) completed the intervention. Participants who received the cost of continued smoking frame were significantly more likely to intend to talk to their physician about participating in a tobacco treatment trial than those who received the benefits of the quitting frame (mean costs 5.13, SD 1.70 vs mean benefits 4.23, SD 1.86; P=.04). Participants who received the proximal risks of continued smoking frame were significantly more likely to seek more information about participating (mean distal 4.83, SD 1.61 vs mean proximal 5.55, SD 1.15; P=.04), and those who received the losses of not participating frame reported significantly improved perceptions of smoking cessation research (mean gain 3.98, SD 0.83 vs mean loss 4.38, SD 0.78; P=.01). Male participants (P=.006) and those with greater message relevancy (P=.001) were significantly more likely to intend to talk to their physician. Participants’ perceptions of their smoking habits, as well as their motivation to quit smoking, were prevalent themes in the open-text data. Differences in the percentages of affective words across message frames were identified. Conclusions Multimethod approaches are needed to develop evidence-based recruitment messages for patients recently diagnosed with cancer. Future tobacco treatment trials should evaluate the effectiveness of different message frames on smoker enrollment rates. Trial Registration Clinicaltrials.gov NCT05471284; https://clinicaltrials.gov/ct2/show/NCT05471284

BACKGROUND A cancer diagnosis can catalyze motivation to quit smoking. Tobacco treatment trials (TTTs) offer evidence-based cessation resources but suffer from low accrual rates. Digital outreach through clinician-delivered videos may improve recruitment efforts. However, understanding of how best to frame trial information and promote participation among smokers with a recent diagnosis is limited. OBJECTIVE This study aimed to identify which message frames were most effective at promoting intent to talk to a doctor about participating in a TTT for smokers recently diagnosed with cancer. METHODS From February-April 2019, current smokers diagnosed within the past 24 months were recruited from a national online panel company to a multi-method pilot randomized trial (N=99). Participants were randomly assigned to 1 of 9 videos in a 2 x 3 plus control factorial design that tested 3 unique message frame: (1) proximal vs. distal threats of smoking, (2) costs of continued smoking vs. benefits of quitting, and (3) gains of participating vs. loss of not participating in a TTT. The primary outcome was self-assessed intent to talk to a doctor about participating in a TTT. Phase 1: Analysis of variance examined the main effect within each message factor level and compared to control condition. Other message evaluation and effectiveness measures were also collected. A multivariable model explored sociodemographic, smoking and cancer characteristics, and message measures associated with intent to talk to a doctor. Phase 2: Open-text evaluations of the messages were analyzed using natural language processing software (Leximancer) to generate a thematic concept map and Linguistic Inquiry Word Count to identify and compare prevalence of linguistic markers between message factors. RESULTS A total of 76 participants completed the intervention. Participants who received the cost of continued smoking message frame were significantly more likely to intend to talk to their doctor about participating in a TTT than those who received the benefits of quitting frame (Mcosts=5.13 vs. Mbenefits=4.23, P=.038). Participants who received the proximal risks of continued smoking message frame were significantly more likely to seek more information about participating (MDistal=4.83 vs. MProximal=5.55, P=.04), and those who received the losses of not participating frame reported significantly improved perceptions about smoking cessation research (MGain=3.98 vs. MLoss=4.38, P=.013). Male participants (P=.006) and those with greater message relevancy (P=.001) were significantly more likely to intend to talk to their doctor. Participants’ perceptions about their smoking habits, as well as their motivation and readiness to quit smoking, were the most prevalent themes in the open-text data. Differences across message frames in the percentage of affective words were identified. CONCLUSIONS Multi-method approaches are needed to develop evidence-based recruitment messages for patients recently diagnosed with cancer. Future TTTs should evaluate the effectiveness of different message frames on smoker enrollment rates.

<b><i>Introduction:</i></b> Smoking after a cancer diagnosis represents a modifiable health risk. It is recommended that oncology clinicians address tobacco use among their patients using the 5As brief model: Asking about use, Advising users to quit, Assessing willingness to quit, Assisting in quit attempts (counseling and medication), and Arranging follow-up. However, cross-sectional studies have found limited adoption of 5As (especially Assist and Arrange) in oncology settings. Further investigation is needed to understand changes in, and factors associated with, 5As delivery over time. <b><i>Methods:</i></b> Patients recently diagnosed with cancer and reporting current smoking (<i>N</i> = 303) enrolled in a smoking cessation clinical trial and completed three longitudinal surveys; at pre-intervention baseline and 3- and 6-month follow-up post-enrollment. Patient-level correlates of 5As receipt at baseline, 3 months, and 6 months were identified using multilevel regression models. <b><i>Results:</i></b> At baseline, patient-reported rates of 5As receipt from oncology clinicians ranged from 85.17% (Ask) to 32.24% (Arrange). Delivery declined from baseline to 6-month follow-up for all 5As, with the largest declines observed for Ask, Advise, Assess, and Assist-Counseling. Diagnosis of a smoking-related cancer was associated with greater odds of 5As receipt at baseline but lower odds at 6-month follow-up. At each time point, female gender, religiosity, advanced disease, cancer-related stigma, and smoking abstinence were associated with lower odds of 5As receipt, while reporting a recent quit attempt prior to enrollment was associated with higher odds of 5As receipt. <b><i>Conclusion:</i></b> Oncology clinicians’ 5As delivery declined over time. Clinician delivery of the 5As varied based on patients’ sociodemographics, clinical and smoking characteristics, and psychosocial factors.

Background Screen ASSIST is a cessation trial offered to current smokers at the point of lung cancer screening. Because of the unique position of promoting a prevention behavior (smoking cessation) within the context of a detection behavior (lung cancer screening), this study employed prospect theory to design and formatively evaluate a targeted recruitment video prior to trial launch. Objective The aim of this study was to identify which message frames were most effective at promoting intent to participate in a smoking cessation study. Methods Participants were recruited from a proprietary opt-in online panel company and randomized to a 2 (benefits of quitting vs risks of continuing to smoke at the time of lung screening; BvR) × 2 (gains of participating vs losses of not participating in a cessation study; GvL) message design experiment (N=314). The primary outcome was self-assessed intent to participate in a smoking cessation study. Message effectiveness and lung cancer risk perception measures were also collected. Analysis of variance examined the main effect of the 2 message factors and a least absolute shrinkage and selection operator (LASSO) approach identified predictors of intent to participate in a multivariable model. A mediation analysis was conducted to determine the direct and indirect effects of message factors on intent to participate in a cessation study. Results A total of 296 participants completed the intervention. There were no significant differences in intent to participate in a smoking cessation study between message frames (P=.12 and P=.61). In the multivariable model, quit importance (P<.001), perceived message relevance (P<.001), and affective risk response (ie, worry about developing lung cancer; P<.001) were significant predictors of intent to participate. The benefits of quitting frame significantly increased affective risk response (Meanbenefits 2.60 vs Meanrisk 2.40; P=.03), which mediated the relationship between message frame and intent to participate (b=0.24; 95% CI 0.01-0.47; P=.03). Conclusions This study provides theoretical and practical guidance on how to design and evaluate proactive recruitment messages for a cessation trial. Based on our findings, we conclude that heavy smokers are more responsive to recruitment messages that frame the benefits of quitting as it increased affective risk response, which predicted greater intention to participate in a smoking cessation study.

BACKGROUND Screen ASSIST is a cessation trial offered to current smokers at the point of lung cancer screening. Because of the unique position of promoting a prevention behavior (smoking cessation) within the context of a detection behavior (lung cancer screening), this study employed prospect theory to design and formatively evaluate a targeted recruitment video prior to trial launch. OBJECTIVE The aim of this study was to identify which message frames were most effective at promoting intent to participate in a smoking cessation study. METHODS Participants were recruited from a proprietary opt-in online panel company and randomized to a 2 (benefits of quitting vs risks of continuing to smoke at the time of lung screening; BvR) × 2 (gains of participating vs losses of not participating in a cessation study; GvL) message design experiment (N=314). The primary outcome was self-assessed intent to participate in a smoking cessation study. Message effectiveness and lung cancer risk perception measures were also collected. Analysis of variance examined the main effect of the 2 message factors and a least absolute shrinkage and selection operator (LASSO) approach identified predictors of intent to participate in a multivariable model. A mediation analysis was conducted to determine the direct and indirect effects of message factors on intent to participate in a cessation study. RESULTS A total of 296 participants completed the intervention. There were no significant differences in intent to participate in a smoking cessation study between message frames (<i>P</i>=.12 and <i>P</i>=.61). In the multivariable model, quit importance (<i>P</i>&lt;.001), perceived message relevance (<i>P</i>&lt;.001), and affective risk response (ie, worry about developing lung cancer; <i>P</i>&lt;.001) were significant predictors of intent to participate. The benefits of quitting frame significantly increased affective risk response (Mean_benefits 2.60 vs Mean_risk 2.40; <i>P</i>=.03), which mediated the relationship between message frame and intent to participate (<i>b</i>=0.24; 95% CI 0.01-0.47; <i>P</i>=.03). CONCLUSIONS This study provides theoretical and practical guidance on how to design and evaluate proactive recruitment messages for a cessation trial. Based on our findings, we conclude that heavy smokers are more responsive to recruitment messages that frame the benefits of quitting as it increased affective risk response, which predicted greater intention to participate in a smoking cessation study.