Patient involvement in decision making is widely regarded as a feature of high quality health care. This has increased interest in decision aids, tools designed to facilitate patient participation in decision making about their care that present true choices, each involving harms and benefits. Potential benefits of using decision aids, beyond maximizing patient autonomy, include increased patient compliance with choices, and hopefully, improved health outcomes. Tobacco use is the single most important preventable cause of disease, including cancer. Practice guidelines provide recommendations for clinician-provided tobacco interventions (the "5As"), which include strong, personalized recommendations to quit, regardless of patient preference. Unfortunately, it has proved difficult to disseminate this approach in actual clinical practice. Decision aids are designed to facilitate clinician-patient interactions, and could prove to be practical tools to help clinicians discuss tobacco use with their patients, but have never been applied to decisions related to tobacco use behavior. The scheduling of elective surgical procedures (occurring in approximately 10 million American smokers each year) represents an opportunity to explore the use of decision aids applied to tobacco control. For those requiring elective surgery, even brief perioperative abstinence reduces immediate postoperative complications;the additional benefit to long-term health of permanent abstinence is clear. Surgical patients who smoke thus face three immediate choices: 1) continue to smoke both immediately before and after surgery, 2) attempt to maintain temporary abstinence from smoking in the perioperative period or 3) use surgery as an opportunity to quit smoking for good. Because the surgical date represents a firm point of decision, this setting represents an excellent opportunity to explore the novel concept of using a decision aid to facilitate discussions of tobacco use between clinicians and smokers. The overall goal of this proposal is to develop and pilot test a decision aid that will increase patient involvement in decisions regarding smoking behavior of cigarette smokers scheduled for elective surgery. In the first specific aim, a novel practice-based, patient-centered method will be used to develop a decision aid to help patients scheduled for elective surgery decide whether to continue to smoke, attempt temporary perioperative abstinence, or make a sustained quit attempt. In the second aim, smokers scheduled for elective surgery will be randomized to receive a brief intervention based on the usual "5As" approach or an approach incorporating the decision aid developed in Specific Aim 1 to test the hypotheses that the decision aid 1) will increase measures of decisional quality regarding the tobacco use, and 2) the increased quality of decisions will be associated with increases in measures of intent to quit and self-efficacy. Postoperative tobacco use will also be assessed as an exploratory outcome. This project represents the first exploration of whether a formal decision aid designed to be feasible for clinician use can help patients make decisions regarding their tobacco use behavior, which could have a broad impact on cancer risk.
Medical professionals can and should help their patients who smoke quit, but this can be difficult because few of these professionals have the right training and enough time to do so. This project tests a new way that these professionals can help - by using decision aids to help smokers who need surgery decide how to manage their smoking around the time of surgery. Because millions of Americans require surgery each year, if the new method is successful it will help these smokers not only have better results after surgery, but to also gain the dramatic health benefits of quitting smoking.