Cigarette smoking is the leading cause of lung cancer and has been implicated in other cancers such as larynx, oral cavity and pharynx, esophagus, bladder, stomach, liver, kidney, cervix, and myeloid leukemia. Although NCI's Cancer Information Service (CIS) provides substantial resources related to education about the risks of tobacco and support for smoking cessation, these resources are underutilized by health professionals and by persons from traditionally underserved populations. The overall goal of this project is to determine if integration of resources from NCI's CIS into an existing personal digital assistant (PDA)-based mobile decision support system for advanced practice nurses (MODS-APN) increases use of tobacco-related CIS resources by APN students and the underserved populations for whom they provide care. The proposed randomized, controlled trial (RCT) will explore the efficacy of two informatics-based approaches for integrating tobacco-related CIS resources into the clinical workflow: a) MODS-APN:CIS, a PDA-based clinical documentation system that integrates decision support for patient referrals; and b) MODS-APN:CIS plus context-specific access (info buttons) to tobacco-related CIS resources (MODS-APN:CIS-IB). It is estimated that during the two-year study period, 75,000 clinical encounters will be documented by 150 APN students using MODS-APN:CIS and MODS-APN:CIS-IB. Preliminary data suggest that 46.2% of the patients seen by APN students will be Hispanic and 20.9% will be Black, non-Hispanic. Moreover, only 20% will have private health insurance.
The specific aims of the RCT are to: 1. Integrate tobacco-related CIS resources into the clinical workflow of APN students in underserved settings: CIS resources will be integrated into the clinical workflow by extending MODS-APN to create MODS-APN:CIS and by creating a tailored portal for tobacco-related CIS resources to be accessed via MODS-APN:CIS-IB or desktop computer. 2. Evaluate APN students' use and perceptions of ease of use and usefulness of tobacco-related CIS resources in underserved settings. Use patterns will be explored by APN specialty, overtime, and by patient sociodemographic variables (gender, age, race, ethnicity, zip code, and health insurance status). Perceptions of ease of use and usefulness of tobacco-related CIS resources will be compared for access via MODS-APN:CIS-IB or desktop computer. 3. Assess the relationship between APN students' referrals and patients' use of tobacco-related CIS resources. Differences in patients' use of tobacco-related CIS resources will be explored by sociodemographic variables (gender, age, race, ethnicity, zip code, and health insurance status). ? ? ?
