Decision Aid for Cigarette Smokers Undergoing Surgery

为接受手术的吸烟者提供决策援助

• 批准号: 7987053
• 负责人: David O. Warner
• 金额: $ 20.58万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7987053
• 关键词: Abstinence; American; Behavior; Behavioral; Caring; Cigarette Smoker; Clinical Practice Guideline; Data; Decision Aid; Decision Making; Disease; Effectiveness; Elective Surgical Procedures; Emergency Situation; Event; Face; Future; Goals; Guidelines; Health; Health Benefit; Healthcare; Hour; Intervention; Laboratories; Life; Malignant Neoplasms; Measures; Medical; Methods; Operative Surgical Procedures; Outcome; Patient Participation; Patient Preferences; Patient Schedules; Patients; Perioperative; Pilot Projects; Postoperative Complications; Postoperative Period; Practice Guidelines; Prevention strategy; Provider; Randomized; Recommendation; Risk; Schedule; Self Efficacy; Smoke; Smoker; Smoking; Smoking Behavior; Techniques; Testing; Time; Tobacco; Tobacco use; Training; Work; base; brief intervention; cancer diagnosis; cancer risk; clinical practice; compliance behavior; design; health care quality; improved; innovation; interest; motivational enhancement therapy; novel; patient oriented; public health relevance; smoking cessation; smoking intervention; tertiary prevention; theories; tobacco abstinence; tobacco control; tool

DESCRIPTION (provided by applicant): Patient involvement in decision making is widely regarded as a feature of high quality health care. This has increased interest in decision aids, tools designed to facilitate patient participation in decision making about their care that present true choices, each involving harms and benefits. Potential benefits of using decision aids, beyond maximizing patient autonomy, include increased patient compliance with choices, and hopefully, improved health outcomes. Tobacco use is the single most important preventable cause of disease, including cancer. Practice guidelines provide recommendations for clinician-provided tobacco interventions (the "5As"), which include strong, personalized recommendations to quit, regardless of patient preference. Unfortunately, it has proved difficult to disseminate this approach in actual clinical practice. Decision aids are designed to facilitate clinician-patient interactions, and could prove to be practical tools to help clinicians discuss tobacco use with their patients, but have never been applied to decisions related to tobacco use behavior. The scheduling of elective surgical procedures (occurring in approximately 10 million American smokers each year) represents an opportunity to explore the use of decision aids applied to tobacco control. For those requiring elective surgery, even brief perioperative abstinence reduces immediate postoperative complications; the additional benefit to long-term health of permanent abstinence is clear. Surgical patients who smoke thus face three immediate choices: 1) continue to smoke both immediately before and after surgery, 2) attempt to maintain temporary abstinence from smoking in the perioperative period or 3) use surgery as an opportunity to quit smoking for good. Because the surgical date represents a firm point of decision, this setting represents an excellent opportunity to explore the novel concept of using a decision aid to facilitate discussions of tobacco use between clinicians and smokers. The overall goal of this proposal is to develop and pilot test a decision aid that will increase patient involvement in decisions regarding smoking behavior of cigarette smokers scheduled for elective surgery. In the first specific aim, a novel practice-based, patient-centered method will be used to develop a decision aid to help patients scheduled for elective surgery decide whether to continue to smoke, attempt temporary perioperative abstinence, or make a sustained quit attempt. In the second aim, smokers scheduled for elective surgery will be randomized to receive a brief intervention based on the usual "5As" approach or an approach incorporating the decision aid developed in Specific Aim 1 to test the hypotheses that the decision aid 1) will increase measures of decisional quality regarding the tobacco use, and 2) the increased quality of decisions will be associated with increases in measures of intent to quit and self-efficacy. Postoperative tobacco use will also be assessed as an exploratory outcome. This project represents the first exploration of whether a formal decision aid designed to be feasible for clinician use can help patients make decisions regarding their tobacco use behavior, which could have a broad impact on cancer risk. PUBLIC HEALTH RELEVANCE: Medical professionals can and should help their patients who smoke quit, but this can be difficult because few of these professionals have the right training and enough time to do so. This project tests a new way that these professionals can help - by using decision aids to help smokers who need surgery decide how to manage their smoking around the time of surgery. Because millions of Americans require surgery each year, if the new method is successful it will help these smokers not only have better results after surgery, but to also gain the dramatic health benefits of quitting smoking.

描述（由申请人提供）：患者参与决策，被广泛认为是高质量医疗保健的特征。这增加了对决策辅助工具的兴趣，旨在促进患者参与其护理的决策的工具，这些工具呈现出真正的选择，每种都涉及危害和福利。使用决策辅助工具的潜在好处，除了最大化患者自主权之外，还包括患者对选择的遵守情况，并希望能改善健康结果。使用烟草是包括癌症在内的最重要的疾病原因。实践指南为临床医生提供的烟草干预提供了建议（“ 5AS”），其中包括强有力的个性化建议，无论患者的偏爱如何，都包括戒烟。不幸的是，事实证明，在实际的临床实践中很难传播这种方法。决策辅助工具旨在促进临床医生的相互作用，并且可能被证明是帮助临床医生与患者讨论烟草使用的实用工具，但从未应用于与烟草使用行为有关的决策。选修外科手术程序的安排（每年大约1000万美国吸烟者）代表了探索使用用于烟草控制的决策辅助工具的机会。对于那些需要选修手术的人，即使是短暂的围手术期的节制也会减少术后并发症。长期保险的长期健康的额外好处是明显的。因此，吸烟的手术患者因此面对三个立即选择：1）在手术前后，2）试图在围手术期间暂时禁欲吸烟或3）使用手术作为戒烟的机会。由于手术日期代表了一个确定的决策点，因此该环境代表了探索新颖的概念的绝佳机会，即使用决策援助来促进临床医生和吸烟者之间使用烟草使用的讨论。该提案的总体目标是制定和试点测试决策援助，该援助将增加患者参与计划进行选修手术的吸烟者的决策。在第一个特定目标中，将使用一种新型的基于练习的，以患者为中心的方法来开发决策援助，以帮助计划进行选修手术的患者决定是否继续吸烟，尝试临时围手术期的戒酒或进行持续的戒烟尝试。在第二个目的中，计划进行选修手术的吸烟者将被随机分配，以基于通常的“ 5AS”方法或一种在特定目标中开发的决策辅助方法1来检验决策辅助的假设1）将提高对烟草使用的质量的决定质量的方法，以及与决策质量相关联，并与无效相关。术后烟草使用也将作为探索性结果评估。该项目是第一次探索是否适用于临床医生使用的正式决策援助可以帮助患者就其烟草使用行为做出决定，这可能会对癌症风险产生广泛的影响。 公共卫生相关性：医疗专业人员可以并且应该帮助他们的戒烟的患者，但这可能很困难，因为这些专业人员中很少有人接受正确的培训和足够的时间来做到这一点。该项目测试了这些专业人员可以提供帮助的新方法 - 通过使用决策辅助工具来帮助需要手术的吸烟者决定如何在手术期间管理吸烟。由于数百万美国人每年需要手术，因此，如果新方法成功，它将帮助这些吸烟者不仅在手术后取得更好的结果，而且还可以获得戒烟的巨大健康益处。