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一个特征。这增加了人们对决策辅助工具的兴趣，这些工具旨在促进患者参与有关其护理的决策，提供真正的选择，每个选择都涉及危害和益处。除了最大限度地提高患者自主权之外，使用决策辅助工具的潜在好处还包括提高患者对选择的依从性，并有望改善健康结果。烟草使用是导致疾病（包括癌症）的最重要的可预防原因。实践指南为临床医生提供的烟草干预措施（“5A”）提供建议，其中包括强烈的个性化戒烟建议，无论患者偏好如何。不幸的是，事实证明这种方法很难在实际临床实践中传播。决策辅助工具旨在促进临床医生与患者的互动，并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相关的决策。择期外科手术的安排（每年约有 1000 万美国吸烟者进行）为探索如何使用决策辅助工具来控制烟草提供了机会。对于需要择期手术的患者，即使是短暂的围手术期禁欲也能减少术后即刻并发症；永久禁欲对长期健康的额外好处是显而易见的。因此，吸烟的手术患者面临三种直接选择：1）在手术前和手术后立即继续吸烟，2）尝试在围手术期暂时戒烟，或3）利用手术作为永久戒烟的机会。由于手术日期代表了一个坚定的决策点，因此这种设置提供了一个绝佳的机会来探索使用决策辅助工具来促进临床医生和吸烟者之间关于烟草使用的讨论的新概念。该提案的总体目标是开发并试点测试一种决策辅助工具，该辅助工具将增加患者参与有关计划择期手术的吸烟者吸烟行为的决策。在第一个具体目标中，将使用一种新的基于实践、以患者为中心的方法来开发决策辅助工具，帮助计划进行择期手术的患者决定是否继续吸烟、尝试暂时围手术期戒烟或持续戒烟。在第二个目标中，计划进行择期手术的吸烟者将被随机接受基于通常的“5A”方法或结合特定目标 1 中开发的决策辅助的方法的简短干预，以测试决策辅助 1) 将增加的假设有关烟草使用的决策质量衡量标准，以及 2) 决策质量的提高将与戒烟意向和自我效能衡量标准的提高相关。术后吸烟情况也将作为一项探索性结果进行评估。该项目首次探索了旨在供临床医生使用的正式决策辅助工具是否可以帮助患者做出有关其烟草使用行为的决策，这可能对癌症风险产生广泛的影响。 公共卫生相关性：医疗专业人员可以而且应该帮助吸烟的患者戒烟，但这可能很困难，因为这些专业人员中很少有人接受过适当的培训和足够的时间来这样做。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控制吸烟。由于每年有数百万美国人需要手术，如果新方法成功，它将不仅帮助这些吸烟者在手术后获得更好的结果，而且还能获得戒烟带来的巨大健康益处。