Testing a Clinician and Patient Intervention to Promote smoking Cessation Among Pregnant Women

测试临床医生和患者的干预措施以促进孕妇戒烟

• 批准号: 10412930
• 负责人: JUDY C CHANG
• 金额: $ 57.06万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10412930
• 关键词: Abstinence; Biochemical; Clip; Communication; Communication Programs; Counseling; Coupling; Discipline of obstetrics; Double Effect; Empathy; Evidence based intervention; Exercise; Feedback; Guidelines; Health Care Costs; Individual; Infant Care; Intervention; Light; Low Birth Weight Infant; Meta-Analysis; Modeling; Mothers; Oncologist; Online Systems; Outcome; Patients; Perception; Perinatal; Phase; Postpartum Abstinence; Postpartum Period; Pregnancy; Pregnancy Outcome; Pregnant Women; Premature Birth; Public Health; Randomized; Randomized Controlled Trials; Reporting; Self Efficacy; Site; Smoke; Smoking; Suggestion; Testing; Text; Text Messaging; Touch sensation; Training; Training Programs; United States; Woman; Work; arm; base; cost; design; efficacy outcomes; expectation; improved; individualized feedback; infant death; infant morbidity/mortality; intervention effect; maternal morbidity; negative affect; neonatal morbidity; pediatrician; pilot test; post intervention; pregnant; primary outcome; programs; recruit; secondary outcome; skills; smoking abstinence; smoking cessation; smoking during pregnancy; text messaging intervention; theories; treatment arm; web-based intervention

Perinatal smoking negatively affects the baby and mother as well as healthcare costs; yet, up to one third of women who smoke continue to do so during pregnancy. We tested an SMS texting program and found we could help 10% quit. This quit rate is promising given the light touch and far‐reach of a texting intervention. We want to build on this work to help more pregnant women quit. We will pair the texting intervention with another far‐reaching intervention, clinician counseling —an evidence‐based intervention that has been shown to increase rates of smoking cessation. Despite national guidelines to implement the 5 Aʹs—Ask, Advise, Assess, Assist and Arrange—most obstetric clinicians only Ask and Advise, the least effective of the five. By improving OB clinicians' smoking cessation counseling skills, we can potentially double the effect of the SMS texting program and twice as many women quit. We have already designed and piloted an interactive, individually‐tailored, web‐based communication training program. The program uses clips from OB clinicians' own audio‐recorded encounters, and provides constructive, individualized feedback and suggestions for incorporating the 5 Aʹs. The program is modeled after our other communication training programs that successfully improved pediatrician use of the 5 Aʹs and oncologist use of empathic communication. We propose a randomized, controlled trial to assess whether use of the communication program improves cessation rates among pregnant women who smoke and whether it improves OB clinician smoking cessation counseling. First, we will recruit 50 clinicians and will audio record 4 encounters in the Pre‐ Intervention Phase that will be used to tailor the intervention and assess baseline communication skills. Then, we will randomize half of the clinicians to receive a tailored, web‐based intervention that contains didactic information interactive exercises, and audio clips from their Pre‐Intervention recordings to promote their use of the 5 Aʹs. Clinicians in the control arm will receive the standard smoking cessation counseling web‐based designed for obstetricians. We will recruit 550 patients (11 per clinician), all who will receive the texting intervention, and will audio record their encounters. We will use an intent‐to‐treat analysis to compare our primary outcome, biochemically‐validated cessation at the end of pregnancy, among patients of intervention (n=275) and patients of control OB clinicians (n=275). Additionally, we will assess clinician use of the 5A's in smoking cessation counseling, patient perceptions of communication as well as smoking postpartum. If successful, this program would have an exponential impact on increasing smoking cessation and improving pregnancy outcomes.

围产期吸烟对婴儿和母亲以及医疗保健费用产生负面影响；然而，最多三分之一 在怀孕期间，吸烟的妇女继续这样做。我们测试了一个短信发短信计划，发现我们 可以帮助10％退出。该退出的速度被承诺将对发短信干预的轻微接触和遥远的理论。 我们希望以这项工作为基础，以帮助更多的孕妇退出。我们将将短信干预与 另一个深远的干预措施，临床咨询 - 一种基于证据的干预措施已显示 增加戒烟的速度。尽管国家指导方针实施5个A a，sust，建议， 评估，协助和安排 - 大多数产科临床医生仅询问和建议，这是五个中最不可能的。经过 提高OB临床医生的戒烟咨询技巧，我们可能会使SMS的效果增加一倍 发短信计划，妇女辞职的两倍。我们已经设计并试行了互动， 对基于Web的通信培训计划进行单独量身定制。该程序使用OB的剪辑 临床医生自己的音频接触，并提供建设性的个性化反馈和 建议合并5个aʹs。该程序是按照我们的其他沟通培训进行建模的 成功改善儿科医生使用5个AʹS和肿瘤科医生使用同理心的计划 沟通。我们提出了一项随机，对照试验，以评估是否使用通信 计划提高了吸烟的孕妇的停止率以及是否改善OB临床医生 戒烟咨询。首先，我们将招募50位临床医生，并将在前 干预阶段将用于调整干预和评估基线沟通技巧。然后， 我们将一半的临床医生随机接受量身定制的基于网络的干预措施，其中包含教学法 信息互动练习和从干预前的录音中的音频剪辑以促进其使用 在5个a。控制臂中的临床医生将获得标准的戒烟咨询 专为产科医生设计。我们将招募550名患者（每位临床医生11名），他们将收到短信 干预，并将音频记录他们的相遇。我们将使用意图进行治疗分析来比较我们的 主要结果，在妊娠结束时在生化验证的停止中，干预患者 （n = 275）和对照OB临床医生的患者（n = 275）。此外，我们将评估5A的临床使用 戒烟咨询，对沟通的患者看法以及产后吸烟。如果 成功，该计划将对增加的戒烟和改善产生指数影响 怀孕结果。