Skip to main content
OpenTrials
Completed

NCT Number: NCT02764385

Using a Teachable Moment Communication Process to Improve Outcomes of Quitline Referrals

This study will compare the effectiveness of two approaches for delivering smoking cessation advice in the primary care setting. Ask-Advise-Connect (AAC) is a strategy that uses the electronic health record (EHR) to prompt clinical staff to Ask if the patient smokes, Advise them to quit and, if they're interested, Connect them to Quitline (QL) counseling services. The connection occurs when a QL counselor is notified of the patient's interest, and then calls the patient to enroll in treatment. AAC has been shown to be very effective at enrolling patients, however, it was found that less than 42% of patients who agreed to be referred were successfully contacted by the QL after 5 call attempts. This indicates that many patients that are referred are not ready for cessation, but may feel obligated to accept the referral from their primary care team. This presents an opportunity to improve the patient centeredness of the referral process.

To overcome these limitations, the investigators propose pairing it with a patient-centered smoking cessation approach called the Teachable Moments Communication Process (TMCP). The investigators' team developed this communication strategy, which incorporates patients' concerns into a partnership-oriented discussion about smoking cessation. The investigators propose that combining these two approaches could increase appropriate referrals to the QL, increase the likelihood of successful patient contact and enrollment, and increase the patient's rating of the value of the experience.

Completed

Looking for future studies?

Notify Me

Key information

Conditions

Smoking Behavior Chemically-Induced Disorders Mental Disorders Substance-Related Disorders Tobacco Dependence Tobacco Use Disorder

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

About this study

The investigators specifically aim to:

  • Improve delivery and documentation of smoking cessation advice and assistance to socially and economically disadvantaged patients using an AAC approach integrated into the EHR.
  • Test the effect of combining the TMCP with AAC on process, Quitline referral and smoking outcomes.
  • Examine the narratives of subgroups of individuals to better understand the referral experience and identify ways to improve it.

The investigative research team will conduct a randomized trial to implement these strategies with 8 clinics serving more than 25,000 patients who smoke. The investigators first implement the AAC system change intervention and then use a stepped wedge design to implement the TMCP in 8 clinics that are randomly assigned to a time point (step) for receiving the TMCP intervention. The investigators will collect data via patient survey, EHR and Quitline. The investigators also will conduct in-depth interviews with sub-groups of patients to inform ways to improve the referral process. With mounting demand for systems-based solutions for providing tobacco cessation assistance, it is urgent to understand how to use a systems approach like the AAC in a way that attends to the patient experience. The findings from this study will be useful to clinicians, patients, healthcare systems, and health insurance plans.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • All adults age 18+ who present for visits at participating clinics

Exclusion criteria

  • Any individual under 18 years of age presenting for a clinic visit

Treatment and study plan

Teachable Moment Communication Process

Other

A clinician-focused intervention designed to guide an approach to discussing smoking cessation during routine primary care visits.

AAC

Other

A system-based change to the EHR that allows for eReferral to the Quitline coupled with role and process changes for medical technical assistants

Primary outcomes

  1. Number of Patients Contacted for Quitline Enrollment

    Time frame: Every visit until end of study, up to 6 months post TMCP implementation

    The number of patients contacted by the Quitline among those ready to quit and who accepted a referral to the quitline

Secondary outcomes

  1. Number of Patients With Documentation of Brief Advice

    Time frame: Every visit until end of study, up to 6 months post TMCP implementation

    The number of patients that use tobacco with documentation of brief advice

Sponsors and collaborators

Lead sponsor

Case Western Reserve University

Other

Collaborators

  • Patient-Centered Outcomes Research Institute

Registry information

Important dates

Study start
2016
Primary completion
2019
Study completion
2019
First posted
May 6, 2016
Registry last updated
Jul 27, 2021

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

Related clinical trials

Published trials that share one or more normalized conditions with this study.