Engaging Patients in Tobacco Cessation Resources in Dental Settings

Study Overview
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Brief Summary
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The overarching goal of this project is to reduce smoking-associated morbidity and mortality by increasing the number of patients who are referred for tobacco cessation counseling. Using a stratified, group-randomized, controlled, 2-arm trial conducted in two settings, the investigators will compare smoking-related clinical decision support (CDS) to usual care.

Detailed Description
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This project aims to reduce smoking-associated morbidity and mortality by increasing the number of patients who are referred for tobacco cessation counseling. The study team will evaluate the effectiveness of clinical decision support (CDS) to improve dental provider delivery of brief tobacco interventions and referrals to tobacco quitlines for further tobacco counseling. The CDS will generate personalized, evidence-based recommendations for dentists and dental hygienists to actively engage their smoking patients in the course of usual dental care. Subsequently, the study team will assess the tobacco cessation actions of smokers using patient-centered outcomes.

Official Title
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A Clinic-randomized Trial of a Clinical Decision Support System to Improve Dental Provider Delivery of Brief Tobacco Interventions and Quitline Referrals

Conditions
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Smoking

Intervention / Treatment
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* Other: Clinical Decision Support


Participation Criteria
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Eligibility Criteria
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DENTAL STUDENTS AND DENTAL HYGIENE STUDENTS Inclusion Criteria: 3rd and 4th year predoctoral students or dental hygiene students enrolled at selected dental schools PRIVATE PRACTICE DENTISTS & HYGIENISTS Inclusion Criteria: General practice dentists or dental hygienists practicing at selected private practice clinics Exclusion Criteria: Providers not able or willing to record current tobacco use status in their electronic health record Providers affiliated with selected dental schools who hold a current teaching or clinical position PATIENTS Inclusion Criteria: Current cigarette smokers Exclusion Criteria: patients requesting to opt out of research

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Usual Care<br>Usual care, practitioners review clinical guidelines for tobacco during consent process. | |
| Experimental: Clinical Decision Support<br>The clinical decision support will provide clinical practice guideline-supported, evidence-based, and personalized scripts that are tailored based on patients' self-reported smoking attributes to deliver interventions consistent with the standard of care. | Other: Clinical Decision Support<br>* The clinical decision support will provide clinical practice guideline-supported, evidence-based, and personalized scripts that are tailored based on patients' self-reported smoking attributes to deliver interventions consistent with the standard of care<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of Smokers With Delivery of Brief Interventions and/or Referral to Treatment | Composite of provider actions reported by patient regarding delivery of brief interventions and/or referral to treatment. These actions included that the provider 1) delivered a brief smoking intervention by discussing, a)developing a quit plan or b)setting a quit date or c)using medications to help patients quit or d)discussed strategies for quitting. The provider made a 2) referral to a quitline; a)provided information about how to contact a tobacco quitline or b) arranged for the patient to be contacted by the tobacco quit line for smoking cessation. The composite is satisfied if the patient reports that any of the intervention activities or referral was delivered by the provider. | within a week of the index dental encounter | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of Smokers With Initial Actions Related to Cessation | Composite of patient-reported actions of smokers with initial actions related to cessation. This composite is met if the patient reported that they contacted a smoking cessation quitline, set a quit date, developed a plan to quit, or is starting nicotine replacement or other medication to help quit within 1-7 days of their index dental visit. | within a week of index dental encounter | 
| Percentage of Smokers With Long-term Actions Related to Cessation | Composite of patient-reported actions of smokers with long-term actions related to cessation. This composite includes whether the patient reported that they quit smoking (stopped smoking for more than one day because they were trying to stop smoking), or reduced their smoking use (50% reduction in amount smoked at 6 months compared to baseline). This composite is satisfied if the patient reports that they have done any of these actions within the 6 months +/- 1 week period between the index dental visit and the date of the second patient survey. | within six-months of index dental encounter | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Decision Support Systems, Clinical, Smoking reduction, Smoking cessation, Smoking, Tobacco