Combining Default Choices and a Decision Aid to Improve Tobacco Cessation

Center for Primary Care and Public Health (Unisante), University of Lausanne, Switzerland287 enrolled

Overview

The FIRST cluster randomized trial will evaluate the effect of 1) a training program encouraging general practitioners to offer smoking cessation treatment as a default choice to all current smokers consulting a general practitioner (GP), and 2) an interactive, electronic decision aid to guide smoking cessation treatment, on the proportion of current smokers seen in primary care who have quit smoking 6 months after a baseline visit to their GP, as compared to enhanced usual care.

Smoking cessation medications are underused in primary care, likely because general practitioners (GP) lack detailed knowledge about prescribing and the fact that smokers seen in primary care must "opt-in" to treatment. Currently GPs only offer treatment to patients who say they are ready to quit smoking and desire treatment, making the default choice no treatment. Those who are not ready to quit or are hesitant do not discuss quitting or learn about options to help them quit. Further, GPs often lack confidence to discuss smoking cessation medications or do not provide patients with a choice. A decision aid can both help to present quitting with a medication as the default choice and promote shared decision making by allowing patients to see the menu of options available. The current study will combine the use of 'default choices' when approaching smokers and shared decision making with a decision aid for choosing between smoking cessation treatments. The investigators will train GPs to offer smoking cessation as the default choice while involving patients in key decisions using a decision aid. This innovative approach has not been tested in primary care and has the potential to increase the number of current smokers who make a quit attempt with a proven quit aid, thereby increasing the number of patients who quit smoking. The investigators will implement the training as part of the Vivre sans tabac programme for GPs run by the Swiss Medical Association (FMH).

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

SINGLE

Conditions

Smoking Cessation

Interventions

Training program and decision aidBEHAVIORAL

1\) a one-time, in-person, 2.5-hour training program encouraging participating GPs to present quitting smoking with a quit aid as the default choice to their eligible patients, and 2) access to an electronic decision aid that presents available quit aids. The 2.5-hour training program consists of: 1.5 hours of didactic teaching, with information about pharmacologic quit aids, electronic cigarettes, presenting quitting as a default choice, the decision aid, and a video of a model consultation. This is followed by 1 hour of role plays to practice presenting quitting as a default choice using the decision aid.

Refresher courseBEHAVIORAL

A 45-minute refresher training about smoking cessation that does not aim to change GP behaviour. It will include the same information about pharmacologic quit aids and electronic cigarettes.

Eligibility

Sex: ALLMin age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

Patient-level inclusion criteria: * Consider the GP they are seeing in consultation to be their primary care doctor * Use tobacco daily (cigarettes, cigars, smokeless tobacco) * ≥18 years of age at the time of inclusion Patient-level exclusion criteria: * Consulting for an urgent complaint that precludes even a brief discussion of smoking cessation * Inability to follow the procedures of the study, e.g. unable to read French-language consent materials, severe psychiatric disorders, dementia, etc. * Previous enrolment in a smoking cessation trial \<1 year prior * Current daily user of a pharmacologic smoking cessation aid GP-level inclusion criteria: * GP in private practice in French-speaking Switzerland (Vaud, Geneva, Jura, Neuchâtel, Fribourg or Valais) or metropolitan France * Primarily French-speaking patients with \>80 individual patients seen in a typical month GP-level exclusion criteria: * Completed an intensive smoking cessation curriculum \<2 years prior (ie. at least half-day of training) * Have plans to retire or relocate outside of Switzerland or France in \<12 months

Locations (2)

Maison de santé Mermoz

Lyon, France

Unisante

Lausanne, Canton of Vaud, Switzerland

Outcomes

Primary Outcomes

Smoking cessation

Self-reported, 7-day point-prevalence smoking abstinence

Time frame: 6 months follow-up after the baseline visit with a General Practitioner

Secondary Outcomes

Exhaled Carbon monoxide - patient

Chemical confirmation of abstinence among those who report 7-day smoking abstinence

Time frame: 6 month follow-up

Continuous abstinence - patient

Self-reported continuous abstinence from the patient's quit date among those who report 7-day smoking abstinence

Time frame: 6 month follow-up

Smoking cessation - patient

Self-reported, 7-day point-prevalence smoking abstinence

Time frame: 3 weeks and 3 months follow-up

Quit attempts - patient

Self-reported quit attempts (periods of abstinence to try to quit smoking) since the baseline visit

Time frame: 6 month follow-up

Use of quit aids - patient

Self-reported use of a quit aid (pharmacologic, electronic cigarette, or additional medical visits to discuss quitting) since the baseline visit

Time frame: 6 month follow-up

Patient participation - patient

Patient-reported participation in discussions about smoking cessation as measured by the CollaboRATE scale

Time frame: 3 weeks follow-up

Data from ClinicalTrials.gov

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