A Novel Dialectical Behavior Therapy Brief Group Intervention for Cigarette Smoking by Patients With Cancer: An Open Clinical Trial

Ratio of patients enrolled in study to patients responding to advertisement or referred by providers, and ratio of patients enrolled to patients screened and potentially eligible for the study.

Rate of completion of the eight proposed sessions by participants

Quantitative (Likert scale) questions to assess patient experience of intervention

Interventionist adherence to intervention manual will be assessed by having an independent reviewer select 50% of the audiotaped group sessions (the total depends on the number of groups) and complete a checklist of 25 intervention items (yes/no) to see whether the interventionist performed the item

Changes in tobacco use, specifically number of days engaging in cigarette smoking (frequency) and number of cigarettes smoked per day (daily average) will be measured using the Cancer Patient Tobacco Use Questionnaire (C-TUQ) a 22-item self-report survey used to gather information about tobacco use by patients with cancer and cancer survivors.

The Difficulties in Emotion Regulation Scale (DERS) is a 36-item self-report Likert scale used to assess emotional regulation presented as a total score and 6 sub-scores including nonacceptance of emotional responses, difficulty engaging in goal-directed behavior, impulse control difficulties, lack of emotional awareness, limited access to emotion regulation strategies, and lack of emotional clarity

The DASS-21 is a 21-item self-report instrument designed to measure the three related negative emotional states of depression, anxiety, and tension/stress.

Distress tolerance will be measured using the 15-item Distress Tolerance Scale (DTS). The DTS uses a 5-point Likert scale for participants to record responses to items (1 = 'Strongly Agree' to 5 = 'Strongly Disagree'). The total DTS score is calculated by adding the scores of all 15 items together after reverse-coding item 6 (score range 0-75)

Mindfulness will be measured using the Mindfulness Attention Awareness Scale (MAAS), a 15-item self-report instrument designed to assess a core characteristic of dispositional mindfulness, namely, open or receptive awareness of and attention to what is taking place in the present. The MAAS score is the mean of 15 Likert-scale items from 1-6 (score range 1-6)

The MAC-Mini is a 29-item self-rating scale to assess psychological dimensions of in cancer patients of helplessness/hopelessness, anxious preoccupation, fatalism, avoidance, and fighting spirit in their adjustment to the diagnosis and treatment of cancer. Higher scores reflect lower levels of adjustment for all subscales except fighting spirit, with a higher score indicating higher adjustment

The DBT-WCCL is a 59-item self-report Likert scale, with one part assessing coping via DBT skills, the DBT Skills Subscale (DSS), and one part assessing coping via dysfunctional means, the Dysfunctional Coping Subscale (DCS).44 Skills use are measured on a scale from 0 (never used) to 3 (regularly used). Higher scores indicate more frequent use of DBT skills and functional coping behaviors.

The period of intentional abstinence from smoking typically lasting at least 24 hours, to be collected by self-report using a single item Serious Quit Attempt questionnaire

Self-reported cost for interventionist and patient time and expenses will be collected using an interventionist questionnaire

Costs of nicotine replacement therapy will be captured using a single item added to the Cancer Patient Tobacco Use Questionnaire (item 15a)

The impact on smoking cessation or reduction of the length of time between initial cancer diagnosis and administration of the DBT-ST intervention will be measured using the initial diagnosis date of any cancer per the patient's electronic health record and the Cancer Patient Tobacco Use Questionnaire

The impact of group size on outcomes will be measured using the number of persons in each group, provided group size varies