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IIR 19-425 – HSR Study

IIR 19-425
Teachable Moment to Opt-out of Tobacco (TeaM OUT): A Stepped Wedge Cluster Randomized Intervention
Christopher G. Slatore, MD MS
VA Portland Health Care System, Portland, OR
Portland, OR
Funding Period: October 2020 - June 2024


Background: Cigarette smoking is the leading cause of preventable disease in the U.S. Despite decades of slowly declining cigarette use, many older adults still actively smoke. Among Veterans, 22% overall and 17% of those over 50 years old actively smoked in 2015. It is notoriously difficult to quit, despite widespread knowledge among adults about the health hazards of persistent smoking and a frequent desire to quit. Given the prevalence and persistence of tobacco addiction, the U.S. Preventive Services Task Force (USPSTF) recommends that health care professionals offer cessation interventions at every health care encounter. Significance/Impact: The TeaM OUT intervention is specifically designed to increase motivation to quit, reduce roadblocks, and increase access to smoking cessation resources. It is especially focused connecting older active smokers not yet ready to quit to smoking cessation services. TeaM OUT has the potential to result in more frequent and longer periods of abstinence from smoking in this hard-to-reach population. Innovation: TeaM OUT combines a teachable moment with an opt-out, proactive approach to connect patients to existing cessation services using interactive voice response (IVR) technology. IVR is a proactive and affordable way to reach more older active smokers more frequently. Specific Aims: Aim 1: Among patients recently diagnosed with a pulmonary nodule, evaluate the effect of a proactive, teachable moment-based, smoking cessation outreach intervention (TeaM OUT) on increasing engagement with smoking cessation resources compared to Enhanced Usual Care. Aim 2: Evaluate the association of receipt of TeaM OUT with patient-reported seven-day point prevalence nicotine abstinence and quit motivation compared to Enhanced Usual Care. Aim 3: Qualitatively elicit perspectives from key stakeholders to inform acceptability and utility, implementation barriers and facilitators, and scalability of TeaM OUT. Methodology: In aim 1, we use pulmonary nodule registries to identify participants from three VA facilities (VA Portland, Minneapolis VA, Charleston VA). Patients with pulmonary nodules will be contacted after a stepped- wedged randomization at the clinical level. Participants in the intervention arm are called by the IVR Quitline, whereas participants the control arm must proactively choose to call the quitline. Options selected on the quitline will be recorded and analyzed using logistic regression to test if the quitline increases engagement with smoking cessation services. For aim 2, a subsample of participants in aim 1 will be contacted to complete additional surveys for 12 months after exposure to either arm of the study. We will measure nicotine abstinence, quit motivation, and communication and analyze the measures using multivariable, multi-level hierarchical logistic regression. In aim 3, we will qualitatively assess TeaM OUT by interviewing patient participants twice during the study – first at the time of the initial Proactive IVR contact and second at 13 months after enrollment. Clinical stakeholders will also be interviewed, with a focus on current and desired smoking cessations and experiences with the TeaM OUT intervention. Codes will be derived without preconceived categories. Next Steps/Implementation: We have purposely designed the intervention and overall study to maximize generalizability, feasibility, adoption, and sustainability of the intervention. We plan multiple scientific presentations and publications. Investigators will attend annual American Thoracic Society and HSRD conferences to present the research findings. We will place all de-identified data in our IRB-approved Health Services Research Repository (IRB #3535) at the conclusion of the study. We are creating a detailed toolkit as part of the study’s implementation process so that the IVR system can be easily replicated in multiple settings.

External Links for this Project

NIH Reporter

Grant Number: I01HX003105-01

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Journal Articles

  1. Golden SE, Schweiger L, Melzer AC, Ono SS, Datta S, Davis JM, Slatore CG. "It's a decision I have to make": Patient perspectives on smoking and cessation after lung cancer screening decisions. Preventive medicine reports. 2022 Dec 1; 30:102014. [view]
  2. Reinke LF, Sullivan DR, Slatore C, Dransfield MT, Ruedebusch S, Smith P, Rise PJ, Tartaglione EV, Vig EK, Au DH. A Randomized Trial of a Nurse-Led Palliative Care Intervention for Patients with Newly Diagnosed Lung Cancer. Journal of palliative medicine. 2022 Nov 1; 25(11):1668-1676. [view]
  3. Wang Q, Stone K, Kern JA, Slatore CG, Swanson S, Blackstock W, Khan RS, Smith CB, Veluswamy RR, Chidel M, Wisnivesky JP. Adverse Events Following Limited Resection versus Stereotactic Body Radiation Therapy for Early Stage Lung Cancer. Annals of the American Thoracic Society. 2022 Dec 1; 19(12):2053-2061. [view]
  4. Vranas KC, Hooker ER, Golden SE, Nugent S, Slatore CG. Association of Communication Quality With Patient-Centered Outcomes Among Patients With Incidental Pulmonary Nodules. Chest. 2023 Aug 1; 164(2):556-559. [view]
  5. Slatore CG, Golden SE, Thomas T, Patzel M, Bumatay S, Shannon J, Davis M. Beliefs and Practices of Primary Care Providers Regarding Performing Low-Dose CT Studies for Lung Cancer Screening. Chest. 2022 Mar 1; 161(3):853-859. [view]
  6. Sullivan DR, Wisnivesky JP, Nugent SM, Stone K, Farris MK, Kern JA, Swanson S, Smith CB, Rosenzweig K, Slatore CG. Decision Regret among Patients with Early-stage Lung Cancer Undergoing Radiation Therapy or Surgical Resection. Clinical Oncology (Royal College of Radiologists (Great Britain)). 2023 Jun 1; 35(6):e352-e361. [view]
  7. Gould MK, Creekmur B, Qi L, Golden SE, Kaplan CP, Walter E, Mularski RA, Vaszar LT, Fennig K, Steiner J, de Bie E, Musigdilok VV, Altman DA, Dyer DS, Kelly K, Miglioretti DL, Wiener RS, Slatore CG, Smith-Bindman R. Emotional Distress, Anxiety, and General Health Status in Patients With Newly Identified Small Pulmonary Nodules: Results From the Watch the Spot Trial. Chest. 2023 Jun 24. [view]
  8. Núñez ER, Caverly TJ, Zhang S, Glickman ME, Qian SX, Boudreau JH, Miller DR, Slatore CG, Wiener RS. Factors Associated With Declining Lung Cancer Screening After Discussion With a Physician in a Cohort of US Veterans. JAMA Network Open. 2022 Aug 1; 5(8):e2227126. [view]
  9. Kearney LE, Butler C, Nunez ER, Qian S, Slatore CG, Spalluto L, Wiener RS. Highly variable reporting of incidental findings in a national cohort of US veterans screened for lung cancer. Clinical imaging. 2023 Aug 1; 100:21-23. [view]
  10. Hooker ER, Chapa J, Vranas KC, Niederhausen M, Goodlin SJ, Slatore CG, Sullivan DR. Intersection of Palliative Care and Hospice Use Among Patients With Advanced Lung Cancer. Journal of palliative medicine. 2023 Nov 1; 26(11):1474-1481. [view]
  11. Rustagi AS, Byers AL, Brown JK, Purcell N, Slatore CG, Keyhani S. Lung Cancer Screening Among U.S. Military Veterans by Health Status and Race and Ethnicity, 2017-2020: A Cross-Sectional Population-Based Study. AJPM focus. 2023 Jun 1; 2(2):100084. [view]
  12. Gogebakan KC, Lange J, Slatore CG, Etzioni R. Modeling the impact of novel systemic treatments on lung cancer screening benefits. Cancer. 2023 Jan 15; 129(2):226-234. [view]
  13. Núñez ER, Slatore CG, Tanner NT, Melzer AC, Crothers KA, Lewis JA, Fabbrini AE, Brown JK, Wiener RS. National Survey of Lung Cancer Screening Practices in Veterans Health Administration Facilities. American journal of preventive medicine. 2023 Nov 1; 65(5):901-905. [view]
  14. Rozema EJ, Creekmur B, Musigdilok VV, Steltz J, Gould MK, Slatore CG. Patient responses to passive enrollment into a large, pragmatic clinical trial: A qualitative content analysis. Contemporary clinical trials. 2022 Oct 1; 121:106925. [view]
  15. Braithwaite D, Karanth SD, Slatore CG, Zhang D, Bian J, Meza R, Jeon J, Tammemagi M, Schabath M, Wheeler M, Guo Y, Hochhegger B, Kaye FJ, Silvestri GA, Gould MK. Personalised Lung Cancer Screening (PLuS) study to assess the importance of coexisting chronic conditions to clinical practice and policy: protocol for a multicentre observational study. BMJ open. 2022 Jun 22; 12(6):e064142. [view]
  16. Nugent SM, Slatore CG, Winchell K, Handley R, Clayburgh D, Chandra R, Hooker ER, Knight SJ, Morasco BJ. Prevalence and correlates of high-dose opioid use among survivors of head and neck cancer. Head & neck. 2023 Aug 1; 45(8):2058-2067. [view]
  17. Sullivan DR, Vranas KC, Delorit M, Golden SE, Slatore CG, Ganzini L, Hansen L. Relationships among clinicians are crucial to successful palliative care integration: a qualitative study in lung cancer. Future oncology (London, England). 2023 Jan 1; 19(3):245-257. [view]
  18. Golden SE, Disher N, Dieckmann NF, Eden KB, Matlock D, Vranas KC, Slatore CG, Sullivan DR. Show me the roads and give me a road map: Development of a patient conversation tool to improve lung cancer treatment decision-making. PEC innovation. 2022 Dec 1; 1:100094. [view]
  19. Unger S, Golden SE, Melzer AC, Tanner N, Deepak J, Delorit M, Scott JY, Slatore CG. Study design for a proactive teachable moment tobacco treatment intervention among patients with pulmonary nodules. Contemporary clinical trials. 2022 Oct 1; 121:106908. [view]
  20. Lewis JA, Samuels LR, Denton J, Matheny ME, Maiga A, Slatore CG, Grogan E, Kim J, Sherrier RH, Dittus RS, Massion PP, Keohane L, Roumie CL, Nikpay S. The Association of Health Care System Resources With Lung Cancer Screening Implementation: A Cohort Study. Chest. 2022 Sep 1; 162(3):701-711. [view]
  21. Lewis JA, Samuels LR, Weems J, Park D, Winter R, Lindsell CJ, Callaway-Lane C, Audet C, Slatore CG, Wiener RS, Dittus RS, Kripalani S, Yankelevitz DF, Henschke CI, Moghanaki D, Matheny ME, Vogus TJ, Roumie CL, Spalluto LB. The Association of Organizational Readiness With Lung Cancer Screening Utilization. American journal of preventive medicine. 2023 Nov 1; 65(5):844-853. [view]
  22. Gundle K, Hooker ER, Golden SE, Shull S, Crothers K, Melzer AC, Slatore CG. Use of Veterans Health Administration Structured Data to Identify Patients Eligible for Lung Cancer Screening. Military medicine. 2023 Jul 22; 188(7-8):e2419-e2423. [view]
Journal Other

  1. Lewis JA, Wiener RS, Slatore CG, Spalluto LB. Doing Versus Documenting Shared Decision-Making for Lung Cancer Screening-Are They the Same? [Abstract]. Journal of the American College of Radiology : JACR. 2022 Aug 1; 19(8):954-956. [view]
  2. Golden SE, Unger S, Slatore CG. Implementing Smoking Cessation Telehealth Technologies Within the VHA: Lessons Learned. [Abstract]. Federal practitioner : for the health care professionals of the VA, DoD, and PHS. 2023 Aug 1; 40(8):256-260. [view]
  3. Rustagi AS, Slatore CG, Keyhani S. Self-Rated Health and Ability to Climb Stairs: A Pragmatic Health Assessment Before Lung Cancer Screening. [Abstract]. Annals of internal medicine. 2023 Apr 1; 176(4):568-571. [view]
  4. Wiener RS, Barker AM, Carter-Harris L, Caverly TJ, Crocker DA, Denietolis A, Doherty C, Fagerlin A, Gallagher-Seaman M, Gould MK, Han PKJ, Herbst AN, Ito Fukunaga M, McCullough MB, Miano DA, Quaife SL, Slatore CG, Fix GM. Stakeholder Research Priorities to Promote Implementation of Shared Decision-Making for Lung Cancer Screening: An American Thoracic Society and Veterans Affairs Health Services Research and Development Statement. [Abstract]. American journal of respiratory and critical care medicine. 2022 Mar 15; 205(6):619-630. [view]

DRA: Substance Use Disorders
DRE: Treatment - Efficacy/Effectiveness Clinical Trial, TRL - Applied/Translational
Keywords: Addictive Disorders, Comparative Effectiveness
MeSH Terms: None at this time.

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