Testing a Clinician and Patient Intervention to Promote smoking Cessation Among Pregnant Women

Duke University, Durham NC

Investigators

Abstract

Perinatal smoking negatively affects the baby and mother as well as healthcare costs; yet, up to one third of women who smoke continue to do so during pregnancy. We tested an SMS texting program and found we could help 10% quit. This quit rate is promising given the light touch and far‐reach of a texting intervention. We want to build on this work to help more pregnant women quit. We will pair the texting intervention with another far‐reaching intervention, clinician counseling —an evidence‐based intervention that has been shown to increase rates of smoking cessation. Despite national guidelines to implement the 5 Aʹs—Ask, Advise, Assess, Assist and Arrange—most obstetric clinicians only Ask and Advise, the least effective of the five. By improving OB clinicians' smoking cessation counseling skills, we can potentially double the effect of the SMS texting program and twice as many women quit. We have already designed and piloted an interactive, individually‐tailored, web‐based communication training program. The program uses clips from OB clinicians' own audio‐recorded encounters, and provides constructive, individualized feedback and suggestions for incorporating the 5 Aʹs. The program is modeled after our other communication training programs that successfully improved pediatrician use of the 5 Aʹs and oncologist use of empathic communication. We propose a randomized, controlled trial to assess whether use of the communication program improves cessation rates among pregnant women who smoke and whether it improves OB clinician smoking cessation counseling. First, we will recruit 50 clinicians and will audio record 4 encounters in the Pre‐ Intervention Phase that will be used to tailor the intervention and assess baseline communication skills. Then, we will randomize half of the clinicians to receive a tailored, web‐based intervention that contains didactic information interactive exercises, and audio clips from their Pre‐Intervention recordings to promote their use of the 5 Aʹs. Clinicians in the control arm will receive the standard smoking cessation counseling web‐based designed for obstetricians. We will recruit 550 patients (11 per clinician), all who will receive the texting intervention, and will audio record their encounters. We will use an intent‐to‐treat analysis to compare our primary outcome, biochemically‐validated cessation at the end of pregnancy, among patients of intervention (n=275) and patients of control OB clinicians (n=275). Additionally, we will assess clinician use of the 5A's in smoking cessation counseling, patient perceptions of communication as well as smoking postpartum. If successful, this program would have an exponential impact on increasing smoking cessation and improving pregnancy outcomes.