Medical doctors, nurses, dentists, and dental hygienists have been shown to be effective in helping their patients quit tobacco. However, Doctors of Chiropractic (DCs) have not been utilized in this role! DCs can provide a unique channel for the conduct of tobacco interventions, but they currently receive little to no training in these techniques. Doctors of Chiropractic are increasingly concerned with patients' use of cigarettes and smokeless tobacco. The chiropractic team provides educational and preventive services to patients, and the office visit can provide an extended opportunity to talk to patients about their tobacco use. Given the health effects associated with chronic tobacco use, the chiropractic visit provides a """"""""teachable moment"""""""" during which the DC can relate current health problems to tobacco use and provide brief counseling to patients who use tobacco. In the proposed developmental study, 8 chiropractic clinics will participate in the design, implementation, and evaluation of an office-based tobacco cessation intervention. Adapted from previous office-based intervention protocols, the intervention will be based on Cognitive Learning Theory and the Clinical Practice Guidelines and will also incorporate Motivational Interviewing techniques. Finally, using the RE-AIM framework, we will assess individual-, clinic-, and organization-level variables that may affect the delivery of treatment for tobacco dependence, the implementation and maintenance of the intervention. This pilot research will be used to develop and refine the design of DC training, study implementation, patient recruitment, data collection, and follow-up procedures to serve as a basis for a future randomized clinical trial.
The specific aims of this R21 application are: 1. To design and refine an established office-based tobacco intervention for use within chiropractic settings. We will adapt the intervention protocol, training format and materials, and patient materials through the use of focus groups, interviews, and written surveys with DCs, office staff, and chiropractic patients. The evaluation of the intervention will be guided by the RE-AIM framework, 2. To develop and refine study implementation protocols, DC and patient recruitment procedures, data collection strategies, and follow-up procedures through an iterative process of engagement with participating chiropractic practitioners, staff and patients. Data will be collected using both quantitative and qualitative methods. 3. Prepare a working Manual of Procedures for a future randomized clinical trial. This study will be conducted in 8 private chiropractic clinics throughout Oregon. The practices will represent a variety of sizes and settings, including both urban and rural locations, scope of practice, and patient demographics. This pilot research is based on complementary lines of previous research, and will be conducted by an interdisciplinary team of highly qualified researchers, including Doctors of Chiropractic, behavioral psychologists, and epidemiologists. The goal of this study is to provide the foundation for a randomized clinical trial with a nationally-representative sample of DCs. ? ? ?
| Gordon, Judith S; Istvan, Joseph; Haas, Mitchell (2010) Tobacco cessation via doctors of chiropractic: results of a feasibility study. Nicotine Tob Res 12:305-8 |
