Maintaining Effective Smoking Cessation Interventions During COVID
By: Tatyana Kanzaveli
Tags: Addiction, Cancer, Lung Cancer, Smoking, Healthtech

UCSF study uses Open Health Network technology to convert clinical study from face to face to online.

Cigarette smoking continues to be one of the leading causes of preventable death in America, responsible for more than 480,000 deaths per year according to the CDC. A major cause of smoking-related death is lung cancer, and more than 8o% of lung cancer deaths in the US every year are attributable to smoking, according to the American Cancer Society.

While countless smokers are concerned about the health consequences of cigarettes, quitting can be extremely challenging. Many individuals at risk for lung cancer simply don’t make an attempt to quit, or fail because they cannot overcome the barriers to quitting. In fact, while more than half of all adult smokers in the US have tried to quit, the CDC reports that just 7.5%

of them succeed. There are smoking cessation programs and medications that can help smokers overcome the barriers to quitting, but healthcare providers often find it difficult to connect patients with these interventions.

UCSF investigators hypothesized that approaching patients about smoking cessation in conjunction with a radiologic test — a screening CT scan for lung cancer — might be effective in persuading them to undertake a cessation program. These low-dose CT scans are often offered to individuals who have a history of smoking in an effort to detect lung cancers at the earliest possible stage. Approaching patients in the clinic immediately before or after the scan could be “a critical moment” for engaging them, said Dr. Judith Walsh, a primary care physician and cancer prevention researcher at UCSF.

“When people have these scans, they are worried about the results, and that potentially makes it a good time to intervene with them to quit,” she said.

A physician-led team at UCSF decided to undertake a study to determine the effectiveness of reaching patients at this stage to engage them in a formal cessation program. As a first step in the CONNECT study, the team needed a tool they could use with patients arriving to undergo CT scans at the UCSF hospital as well as the Veterans Affairs Medical Center in San Francisco, to

offer them an opportunity to enroll in the study.

“Video Doctor” Helps Patients Engage, Enroll, and Personalize Program

UCSF turned to Open Health Network to develop a core piece of the engagement process for the CONNECT study: A “video doctor” application for the Apple iPad. The app was designed to be used by a patient while in the waiting area for a scan. A research associate met with smokers

interested in a cessation program, and offered them the chance to use the application. The video doctor then conducts a virtual interview, and queries patients about their smoking habits and, importantly, what they feel are the individual barriers that have prevented them from quitting or attempting to quit in the past. In addition, the Video Doctor provides suggestions

about how to overcome individual barriers and provides information about available smoking cessation resources.

When a CONNECT study patient receives his or her scan results over the next several days, the UCSF team contacts the patient by phone, asks about their scan and again asks about concerns the patient may have in overcoming their barriers to quitting. Patients would then continue a smoking cessation program that includes both calls from the research team as well as receiving

regular text messages encouraging them to continue not to smoke. Researchers also plan to collect of a saliva sample from the patient at the end of the study, which enables verification of reported smoking cessation.

Based on the answers given to the video doctor app, those video doctor and counseling messages are geared specifically to an individual patient’s concerns, making the program far more personalized in an effort to maximize its effectiveness.

“What’s unique about this intervention is that it is individually tailored,” Walsh noted. “If a patient says, ‘I’m afraid I will gain weight when I stop smoking,’ they will get information on weight control, for example. And it’s done in an interesting and creative way, with video presentations patients can watch on a computer or tablet.”

Reimagining the Project under COVID

As the team was working toward its recruiting goal, the COVID pandemic hit, immediately changing the clinical situation for researchers. Routine cancer screenings were placed on hold for a number of weeks. Even when screenings resumed, under COVID distancing restrictions, it was no longer possible for the researchers to meet patients in person at the clinic to enroll

them.

To continue the project, UCSF worked with Open Health Network to transition the video doctor approach to remote-only operation, so that patients are able to do the initial intake visit from home. Research coordinators contact prospective patients by phone and then share a link to a

web-based version of the video doctor. Following enrollment, patients will receive the same kind of text messages as they had in the past, as well as receiving regular personalized phone calls from the research staff.

It also was important to understand and respond to patient issues unique to the remote approach. The in-person clinic setting allows the research coordinator to directly show patients how to use the iPad and app. For remote settings, the team had to ensure the availability of a coordinator to call and walk patients through use of the web-based app if they needed

guidance.

Lung cancer screening targets those in their 50s, 60s and 70s. Although many participants are comfortable with technology, some are not Walsh said. “For those who are are less comfortable with technology so we developed help for them. In addition, we have developed detailed descriptions of how to use the saliva kit, which can also be completed at home.

Looking Ahead to Other Applications

As the team continues to build enrollment in the pilot study, they also are considering how the video doctor and remote interaction approach could be applied to other important health care needs. For example, patients who come to a hospital with a mild heart attack might have heightened receptiveness to enrolling in a cardiac health program. The personalized text

message and advice aspect could be applied in the case of patients who are, for instance, avoiding a screening procedure because of the possible outcome. The team is soon embarking on a new study where CONNECT will be modified to reach smokers who are undergoing radiation treatment for cancer.