Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
Penn Center for Cancer Care Innovation, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
Implement Sci. 2021 Jul 15;16(1):72. doi: 10.1186/s13012-021-01139-7.
Routine evidence-based tobacco use treatment minimizes cancer-specific and all-cause mortality, reduces treatment-related toxicity, and improves quality of life among patients receiving cancer care. Few cancer centers employ mechanisms to systematically refer patients to evidence-based tobacco cessation services. Implementation strategies informed by behavioral economics can increase tobacco use treatment engagement within oncology care.
A four-arm cluster-randomized pragmatic trial will be conducted across nine clinical sites within the Implementation Science Center in Cancer Control Implementation Lab to compare the effect of behavioral economic implementation strategies delivered through embedded messages (or "nudges") promoting patient engagement with the Tobacco Use Treatment Service (TUTS). Nudges are electronic medical record (EMR)-based messages delivered to patients, clinicians, or both, designed to counteract known patient and clinician biases that reduce treatment engagement. We used rapid cycle approaches (RCA) informed by relevant stakeholder experiences to refine and optimize our implementation strategies and methods prior to trial initiation. Data will be obtained via the EMR, clinician survey, and semi-structured interviews with a subset of clinicians and patients. The primary measure of implementation is penetration, defined as the TUTS referral rate. Secondary outcome measures of implementation include patient treatment engagement (defined as the number of patients who receive FDA-approved medication or behavioral counseling), quit attempts, and abstinence rates. The semi-structured interviews, guided by the Consolidated Framework for Implementation Research, will assess contextual factors and patient and clinician experiences with the nudges.
This study will be the first in the oncology setting to compare the effectiveness of nudges to clinicians and patients, both head-to-head and in combination, as implementation strategies to improve TUTS referral and engagement. We expect the study to (1) yield insights into the effectiveness of nudges as an implementation strategy to improve uptake of evidence-based tobacco use treatment within cancer care, and (2) advance our understanding of the multilevel contextual factors that drive response to these strategies. These results will lay the foundation for how patients with cancer who smoke are best engaged in tobacco use treatment and may lead to future research focused on scaling this approach across diverse centers.
Clinicaltrials.gov, NCT04737031 . Registered 3 February 2021.
常规循证烟草使用治疗可最大程度降低癌症特异性和全因死亡率，减少治疗相关毒性，并提高接受癌症治疗患者的生活质量。很少有癌症中心采用系统地将患者转介至循证烟草戒断服务的机制。基于行为经济学的实施策略可增加肿瘤学护理中烟草使用治疗的参与度。
一项四项臂集群随机实用试验将在癌症控制实施实验室的实施科学中心的九个临床站点中进行，以比较通过嵌入式消息（或“推动”）促进患者参与烟草使用治疗服务（TUTS）实施的行为经济学实施策略的效果。推动是基于电子病历（EMR）发送给患者、临床医生或两者的消息，旨在对抗已知的降低治疗参与度的患者和临床医生偏见。在试验启动之前，我们使用了由相关利益相关者经验提供信息的快速循环方法（RCA）来改进和优化我们的实施策略和方法。数据将通过 EMR、临床医生调查和对部分临床医生和患者的半结构化访谈获得。实施的主要衡量标准是渗透率，定义为 TUTS 转介率。实施的次要结果衡量标准包括患者治疗参与度（定义为接受 FDA 批准的药物或行为咨询的患者数量）、戒烟尝试和戒烟率。半结构化访谈由实施研究综合框架指导，将评估背景因素以及患者和临床医生对推动的体验。
这将是肿瘤学环境中首次比较推动临床医生和患者的有效性，包括头对头和组合比较，作为提高癌症护理中接受循证烟草使用治疗的实施策略。我们预计该研究将：（1）深入了解推动作为提高癌症护理中接受循证烟草使用治疗的实施策略的有效性；（2）增进我们对推动这些策略的多层次背景因素的理解。这些结果将为如何最好地让患有癌症的吸烟者参与烟草使用治疗奠定基础，并可能为未来在不同中心推广这一方法的研究提供依据。
Clinicaltrials.gov，NCT04737031。于 2021 年 2 月 3 日注册。
Zotero 插件