Combining Default Choices and a Decision Aid to Improve Tobacco Cessation (FIRST)

University Center for Primary Care and Public Health (Unisanté)

Status: Completed

Conditions: Smoking Cessation

Treatments: Behavioral: Refresher course; Behavioral: Training program and decision aid

Study type: Interventional

Funder types: Other

Identifiers

NCT04868474

FIRST

Details and patient eligibility

About

The FIRST cluster randomized trial will evaluate the effect of 1) a training program encouraging general practitioners to offer smoking cessation treatment as a default choice to all current smokers consulting a general practitioner (GP), and 2) an interactive, electronic decision aid to guide smoking cessation treatment, on the proportion of current smokers seen in primary care who have quit smoking 6 months after a baseline visit to their GP, as compared to enhanced usual care.

Full description

Smoking cessation medications are underused in primary care, likely because general practitioners (GP) lack detailed knowledge about prescribing and the fact that smokers seen in primary care must "opt-in" to treatment. Currently GPs only offer treatment to patients who say they are ready to quit smoking and desire treatment, making the default choice no treatment. Those who are not ready to quit or are hesitant do not discuss quitting or learn about options to help them quit. Further, GPs often lack confidence to discuss smoking cessation medications or do not provide patients with a choice. A decision aid can both help to present quitting with a medication as the default choice and promote shared decision making by allowing patients to see the menu of options available.

The current study will combine the use of 'default choices' when approaching smokers and shared decision making with a decision aid for choosing between smoking cessation treatments. The investigators will train GPs to offer smoking cessation as the default choice while involving patients in key decisions using a decision aid. This innovative approach has not been tested in primary care and has the potential to increase the number of current smokers who make a quit attempt with a proven quit aid, thereby increasing the number of patients who quit smoking.

The investigators will implement the training as part of the Vivre sans tabac programme for GPs run by the Swiss Medical Association (FMH).

Enrollment: 287 patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion and exclusion criteria

Patient-level inclusion criteria:

• Consider the GP they are seeing in consultation to be their primary care doctor
• Use tobacco daily (cigarettes, cigars, smokeless tobacco)
• ≥18 years of age at the time of inclusion

Patient-level exclusion criteria:

• Consulting for an urgent complaint that precludes even a brief discussion of smoking cessation
• Inability to follow the procedures of the study, e.g. unable to read French-language consent materials, severe psychiatric disorders, dementia, etc.
• Previous enrolment in a smoking cessation trial <1 year prior
• Current daily user of a pharmacologic smoking cessation aid

GP-level inclusion criteria:

• GP in private practice in French-speaking Switzerland (Vaud, Geneva, Jura, Neuchâtel, Fribourg or Valais) or metropolitan France
• Primarily French-speaking patients with >80 individual patients seen in a typical month

GP-level exclusion criteria:

• Completed an intensive smoking cessation curriculum <2 years prior (ie. at least half-day of training)
• Have plans to retire or relocate outside of Switzerland or France in <12 months

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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287 participants in 2 patient groups

Usual care training

Active Comparator group

Description:

A refresher training course will be the equivalent of 'enhanced' usual care. Enhanced because the course will likely augment short-term knowledge of smoking cessation treatments, and participation in the study could trigger more discussions about smoking cessation than routine practice. However, it will be impossible to have any blinding between groups without at least some training.

Treatment:

Behavioral: Refresher course

Intervention training

Experimental group

Description:

The training course and decision aid aim to make treatment of tobacco use the default choice

Treatment:

Behavioral: Training program and decision aid