Feasibility of Patient Navigation-Based Smoking Cessation Program in Cancer Patients
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Setting and Stakeholder Engagement
2.2. Study Population and Recruitment
2.2.1. Inclusion Criteria
2.2.2. Participant Identification
- Never smoked cigarettes;
- Current everyday light smoker (less than 10 cigarettes per day);
- Current everyday heavy smoker (greater than 10 cigarettes per day);
- Current someday light smoker (less than 10 cigarettes per day);
- Current someday heavy smoker (greater than 10 cigarettes per day);
- Former smoker, quit in the last 30 days;
- Former smoker, quit within 31 days–1 year;
- Former smoker, quit greater than 1 year ago;
- Smoker, current status unknown;
- Unknown if ever smoked;
- Patient refused to answer.
2.2.3. Participant Recruitment
2.3. Baseline Assessment
2.4. Study Intervention
2.4.1. Patient Navigator
2.4.2. Smoking Cessation Education Material
2.4.3. First Navigation Session
- (1)
- Asked the patients about current cigarette use.
- (2)
- Advised patients about the risks of continued smoking after cancer diagnosis and the benefits of quitting. For those who just wanted to reduce but not stop smoking entirely, the benefits of reducing were advised. The navigator also discussed nicotine replacement therapy (NRT) or other nicotine products upon the participants’ requests.
- (3)
- Assessed patients’ intention to quit.
- (4)
- Assisted the patients with smoking cessation by referring them to available smoking cessation treatment resources, including PA Free Quitline or Penn State Smoking Cessation Clinic, through the EHR. At the same time, the navigator assisted patients in identifying potential barriers to smoking cessation and referred them to relevant resources if they needed.The Penn State Health Smoking Cessation Clinic, started in July 2018, is a smoking treatment program that involves one-on-one, 30-minute sessions to assess smokers’ nicotine dependence. During the treatment session, they discuss the smokers’ smoking routine, review strategies, and evaluate coping skills. Then, they develop a tailored plan that is specific to each individual smoker’s lifestyle and the lifestyle modifications that will help them quit. The team is also able to prescribe medications to assist in controlling nicotine cravings. Anyone who is currently smoking and has a desire to quit is eligible for this program.The PA Free Quitline is a free phone-based counseling service that addresses cessation needs and impacts statewide tobacco use. It provides a series of up to five phone-based cessation counseling sessions, educational material, and NRT qualified callers [34].
- (5)
- Arranged one-month follow-up calls. At the end of first intervention interview, the date and time for the second patient navigation intervention session were scheduled.
2.4.4. Second Navigation Session
2.4.5. Incentive
2.5. Two-Month Follow-Up Assessment
2.6. Data Collection and Statistical Analysis
3. Results
3.1. Participant Recruitment Flow
3.2. Comparison of Interested and Non-Interested Patients
3.3. Study Participants
3.3.1. Baseline Characteristics
3.3.2. Referral to Smoking Cessation Treatment
3.4. Two-Month Follow Up
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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EHR-Screen Cigarette Smoking Status, N | Clinical Intake Cigarette Smoking Status, N | ||||
---|---|---|---|---|---|
Never | Current | Former | Unknown | Total | |
Never | 0 | 6 | 33 | 0 | 39 |
Current | 8 | 0 | 5 | 0 | 13 |
Former | 69 | 5 | 0 | 2 | 76 |
Unknown | 1 | 2 | 1 | 0 | 4 |
Total | 78 | 13 | 39 | 2 | 132 |
Variables | Total N = 67 | Not Interested N = 43 | Interested N = 24 | p-Value |
---|---|---|---|---|
Age, mean (SD) | 62.0 (6.9) | 62.8 (6.7) | 60.6 (7.2) | 0.21 |
Gender, n (%) | ||||
Male | 43 (64.2) | 29 (67.4) | 14 (58.3) | 0.46 |
Female | 24 (35.8) | 14 (32.6) | 10 (41.7) | |
Race, n (%) | 0.69 | |||
White | 64 (95.5) | 41 (95.4) | 23 (95.8) | |
Black or African American | 2 (3.0) | 1 (2.3) | 1 (4.2) | |
Multiple | 1 (1.5) | 1 (2.3) | 0 (0) | |
Marital status, n (%) | 0.14 | |||
Married | 25 (37.3) | 16 (37.2) | 9 (37.5) | |
Divorced | 13 (19.4) | 11 (25.6) | 2 (8.3) | |
Separated | 2 (3.0) | 2 (4.7) | 0 (0) | |
Single | 20 (29.9) | 9 (20.9) | 11 (45.8) | |
Widowed | 7 (10.4) | 5 (11.6) | 2 (8.3) | |
Cigarette smoking status, n (%) | 0.55 | |||
Current everyday heavy smoker | 26 (38.8) | 15 (34.9) | 11 (45.8) | |
Current everyday light smoker | 30 (44.8) | 19 (44.2) | 11 (45.8) | |
Current someday light smoker | 4 (6.0) | 3 (7.0) | 1 (4.2) | |
Former smoker, quit in the last 30 days | 7 (10.4) | 6 (14.0) | 1 (4.2) | |
Diagnosed of tobacco use disorder, n (%) | 0.11 | |||
Yes | 42 (62.7) | 30 (69.8) | 12 (50.0) | |
No | 25 (37.3) | 13 (30.2) | 12 (50.0) | |
Cessation medication prescription, n (%) | 0.08 | |||
Yes | 10 (14.9) | 4 (9.3) | 6 (25.0) | |
No | 57 (85.1) | 39 (90.7) | 18 (75.0) |
Variables | Total N = 10 |
---|---|
Age, mean (SD) | 58.4 (58.5) |
Male, n (%) | 7 (70) |
White, n (%) | 10 (100) |
Marital status, n (%) | |
Married | 3 (30.0) |
Divorced | 1 (10.0) |
Single | 6 (60.0) |
Education, n (%) | |
Less than high school | 5 (50.0) |
High school graduate | 1 (10.0) |
Some college/no degree | 3 (30.0) |
Associate degree | 1 (10.0) |
Cancer type, n (%) | |
Lung cancer | 8 (80.0) |
Head and neck cancer | 2 (20.0) |
Years of smoking, mean (median) | 44.7 (46.5) |
Cigarettes per day, mean (median) | 13.3 (11.0) |
Smoke menthol cigarettes, n (%) | 5 (50.0) |
Had ever used other tobacco products, n (%) | 4 (40.0) |
Electronic cigarettes | 2 (20.0) |
Cigars | 1 (10.0) |
Pipes | 1 (10.0) |
FTND, mean (median) | 3.9 (4) |
Quit attempts in last 12 months, mean (median) | 5.2 (2) |
Longest time staying quit, n (%) | |
Less than 1 week | 2 (20.0) |
1 week to 1 month | 5 (50.0) |
1 to 6 months | 2 (20.0) |
6–12 months | 1 (10.0) |
Used cessation treatment in the past, n (%) | |
NRT | 10 (100.0) |
Medications | 6 (60.0) |
Behavioral counseling | 1 (10.0) |
Stage of change, n (%) | |
Quit within the next month (preparation) | 5 (50.0) |
Quit within the next six months (contemplation) | 2 (20.0) |
Quit someday, but not next six months (precontemplation) | 3 (30.0) |
Not interested in quitting | 0 (0.0) |
Around smokers most of time, n (%) | 5 (50.0) |
Importance of stopping smoking, mean (median) | 9.7 (10.0) |
Confidence in stopping smoking, mean (median) | 5.3 (5.0) |
Baseline N = 10 | Two-Month Follow up N = 8 | |
---|---|---|
CPD, median | 11 | 6.5 |
Importance of stopping smoking (1–10), median | 10 | 10 |
Confidence in stopping smoking (1–10), median | 5 | 6 |
Stage of change, n (%) | ||
Already quit (action) | - | 2 (25) |
Quit within the next month (preparation) | 5 (50) | 3 (37.5) |
Quit within the next six months (contemplation) | 2 (20) | 3 (37.5) |
Quit someday, but not next six months (precontemplation) | 3 (30) | 0 (0) |
Engage in smoking cessation treatment, n (%) | ||
Behavioral counseling and NRT | - | 4 (50) |
NRT | - | 2 (25) |
Satisfaction with intervention sessions (1–10), median | - | 8.5 |
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Fan, T.; Yingst, J.M.; Bascom, R.; Tuanquin, L.; Veldheer, S.; Branstetter, S.; Foulds, J.; Muscat, J.E. Feasibility of Patient Navigation-Based Smoking Cessation Program in Cancer Patients. Int. J. Environ. Res. Public Health 2022, 19, 4034. https://doi.org/10.3390/ijerph19074034
Fan T, Yingst JM, Bascom R, Tuanquin L, Veldheer S, Branstetter S, Foulds J, Muscat JE. Feasibility of Patient Navigation-Based Smoking Cessation Program in Cancer Patients. International Journal of Environmental Research and Public Health. 2022; 19(7):4034. https://doi.org/10.3390/ijerph19074034
Chicago/Turabian StyleFan, Tongyao, Jessica M. Yingst, Rebecca Bascom, Leonard Tuanquin, Susan Veldheer, Steven Branstetter, Jonathan Foulds, and Joshua E. Muscat. 2022. "Feasibility of Patient Navigation-Based Smoking Cessation Program in Cancer Patients" International Journal of Environmental Research and Public Health 19, no. 7: 4034. https://doi.org/10.3390/ijerph19074034