) Home care is becoming central to the delivery of health services within managed care. The Visiting Nurse Association (VNA) provides a new channel for the delivery of behavioral medicine interventions for cancer prevention and control.
The specific aim of this study is to train VNA nurses to provide their patients who smoke with brief and effective state-of-the-art smoking cessation interventions. A key feature of this proposal is that it takes a public health approach in proactively reaching a patient population who may not otherwise have access to, (or spontaneously seek) treatment. We chose smoking because it remains the leading preventable addictive behavior responsible for chronic disease morbidity and mortality, especially cancer. Older smokers may require motivational enhancement before deciding to quit, given that they have difficulty personalizing health risks and focusing on the benefits of quitting. We propose to randomize and train home health care nurses (N=104) to deliver one of two smoking cessation interventions to their patients over the course of three visits: A Motivational Enhancement (ME) condition (e.g., motivational techniques tailored to the patient's readiness to change and physiological feedback), or a Self-Help (SH) condition (brief advice to quit). Nurses in both groups will receive the new Agency for Health Care Policy and Research (AHCPR) guidelines for smoking cessation, and provide their patients with age-matched smoking cessation manuals. In contrast to the SH group, nurses in the ME group will receive specialized training on motivating smokers to quit. Our primary hypotheses are that the ME intervention will outperform the SH condition on number of quit attempts, greater likelihood of abstinence at 12 months post-treatment, and change in readiness to quit. We will be closely collaborating with VNA nurses at all organizational levels to develop nurse training, facilitate intervention delivery, and ensure quality control.
