A Decision Aid to Improve Smoking Abstinence and HRQL for Families Facing Cancer
Source: American Cancer Society Pre-Doctoral Award (121284-DSCN-11-199-01-SCN)

Period: 07/01/2011 – 07/01/2013
Role: Karen Kane McDonnell (PI)

The long-term goal of this research is to improve outcomes for patients scheduled for thoracic surgery and their family members who smoke cigarettes. The major objective was to develop and test a multidisciplinary, multi-component, theory-based decision aid, “Tobacco Free Family”, as a tailored smoking cessation intervention for patients scheduled to undergo thoracic surgery for a suspicious chest mass or a confirmed cancer and their family members who smoke cigarettes. Read more here.

Compelling evidence exists that continued smoking after a cancer diagnosis has substantial adverse effects. Most cessation interventions focus on individual behavior; however, family members who smoke are barriers to success. The major objective was to develop and test a multidisciplinary, theory-based decision aid, “Tobacco Free Family.” The decision aid encompassed three decisions: “Stop Smoking before Surgery,” “Establish a Smoke-free Home,” and “Stay Smoke-free.”

METHODS: This study’s design was guided by the principles of social cognitive theory and the conflict theory of decision making. Using a 6-month prospective, one-group repeated measures, mixed-method design, this study evaluated recruitment, retention, adherence, and acceptability from the preoperative visit in a university thoracic surgery clinic. The quantitative analysis used descriptive statistics. The qualitative segment used thematic analysis.

RESULTS: Eighteen families were approached and 16 participants (8 families) enrolled (44% recruitment rate, 100% retention rate) over a 6-month recruitment period. Enrolled patients were all male. Enrolled family members were spouses or girlfriends. Patients had greater adherence and rated the decision aid higher (as highly acceptable) compared to family members. Patients had greater abstinence (100%) than family members (25%) before surgery and at 6 months (63% vs. 25%). More than half the families established a smoke-free home. Qualitative interview themes included: (1) The intervention’s timing was convenient and acceptable; (2) involving household family members who smoke was important; and (3) Decision Balance Sheets helped patients and family members reflect on their health and reasons to stop smoking.

CONCLUSIONS: The 56% refusal rate was greater than anticipated, yet similar to other, related studies. This study’s 100% retention rate shows that the enrolled patients and their spouses were motivated to stop smoking and needed and appreciated the support.

Findings suggest that using an interactive theory-based decision aid as part of a family dyad (patient + partner) intervention is feasible. This study offers insights about smoking cessation at the time of a cancer diagnosis. The findings are limited by the one-group design and small sample size. The results will be used to enhance the intervention, its delivery, and fidelity, and to determine a sample size for a full-powered study.