A referral aid for smoking cessation interventions in primary care: study protocol for a randomized controlled trial

Abstract

Background: To expedite the use of evidence-based smoking cessation interventions (EBSCIs) in primary care and to thereby increase the number of successful quit attempts, a referral aid was developed. This aid aims to optimize the referral to and use of EBSCIs in primary care and to increase adherence to Dutch guidelines for smoking cessation. Methods: Practice nurses (PNs) will be randomly allocated to an experimental condition or control condition, and will then recruit smoking patients who show a willingness to quit smoking within six months. PNs allocated to the experimental condition will provide smoking cessation guidance in accordance with the referral aid. Patients from both conditions will receive questionnaires at baseline and after six months. Cessation effectiveness will be tested via multilevel logistic regression analyses. Multiple imputations as well as intention to treat analysis will be performed. Intervention appreciation and level of informed decision-making will be compared using analysis of (co)variance. Predictors for appreciation and informed decision-making will be assessed using multiple linear regression analysis and/or structural equation modeling. Finally, a cost-effectiveness study will be conducted. Discussion: This paper describes the study design for the development and evaluation of an information and decision tool to support PNs in their guidance of smoking patients and their referral to EBSCIs. The study aims to provide insight into the (cost) effectiveness of an intervention aimed at expediting the use of EBSCIs in primary care.

The Usability of an Online Tool to Promote the Use of Evidence-Based Smoking Cessation Interventions

“…The DA was named "StopWijzer", which can be translated as either "stop-guide" or "stop-smarter", and it was based on a needs assessment consisting of a literature review (e.g., [18,43,44]), individual semi-structured interviews with general practitioners (GPs) (n = 5), practice nurses (PNs) (n = 20) and smokers (n = 9), a Delphi study on the referral to EBSCIs [27,39] and the input of an advisory board consisting of experts representing various Dutch smoking cessation-related organizations, six of which were actively involved. After the intervention was pilot-tested, the DA was originally deployed to be used in primary care [41,42]. When necessary, the components were reframed to fit the participants' viewpoints instead of the viewpoint of the PCS.…”

“…The second limitation was that the DA was primarily developed to be used with the aid of a PCP, such as a PN, in the PCS [41,42]. The content of the DA, however, was developed using theoretical grounds based on relevant constructs from the previous studies [18,27,43,44], a needs assessment in the form of a Delphi study [39] and the input of an advisory board.…”

“…The usability of such an overview among PNs and smoking patients willing to quit smoking has been explored in earlier research, revealing a high appreciation for but low uptake of the materials [41,42]. However, due to a low recruitment rate during this randomized controlled trial which evaluated interventions among smokers recruited via the PCS [41], this study retested the usability of the materials among a larger group of smokers to explore whether the materials with minimal modifications were suitable to be offered as an online intervention.…”

How to persuade more primary care professionals to adopt a valued smoking cessation referral aid: a cross-sectional study of facilitators and barriers

“…A brief chapter aimed to discourage the use of non-evidence-based interventions such as acupuncture and e-cigarettes to quit is also included. (For more information on the RA and the associated materials, see [24,25].) The materials are designed to be used in addition to the support offered by the PCPs and not as a substitute for care-as-usual.The first step in the successful dissemination of interventions is successful adoption by the end users, in this case PCPs [26,27].…”

When informed decision making meets health promotion

“…Having said all that, the major potential problem with a stronger embedment within healthcare is that implementation of DAs in clinical practice is known to be suboptimal [307]. That said, Joseph-Williams et al [308] have recently identified strategies to facilitate routine DA-implementation and Zijlstra et al [309] recently developed an intervention similar to a DA that is meant to support consultations in primary care around evidence-based cessation assistance, showcasing that implementation of such interventions is indeed possible. Should VISOR be adapted for healthcare use, it is important to follow the aforementioned strategies to ensure optimal implementation, i.e., (1) the adaption of VISOR should be coproduced with the healthcare providers meant to adopt it to ensure optimal implementation; (2) entire healthcare teams meant to use VISOR should be trained in using it optimally; (3) VISOR's end users (i.e., individuals motivated to quit smoking) should be prepared and prompted to use VISOR; (4) management should be convinced of the added value of VISOR; and (5) data should be collected to showcase actual improvements due to using VISOR [308].…”