EHR nudges increase odds of tobacco use treatment after cancer diagnosis
Click Here to Manage Email Alerts
Key takeaways:
- Patients appeared more than twice as likely to engage in tobacco use treatment after a clinician-focused nudge vs. usual care.
- Advanced practice providers provided tobacco use treatment more often than physicians.
Electronic health record-based nudges aimed at clinicians appeared to increase tobacco use treatment penetration among patients with cancer during oncology encounters, according to data published in Journal of Clinical Oncology.
Such behavioral economic nudges serve as a way to counteract omission bias and “significantly increase the odds” of tobacco use treatment during cancer care, researchers wrote.
“Oncologists are faced with the challenge of responding to each patient’s individual cancer, so we wanted to see if we could develop a strategy for making their lives as easy as possible by providing simple, timely nudges to help patients engage in tobacco use treatment options,” Brian P. Jenssen, MD, MSHP, a researcher and primary care pediatrician with the division of general pediatrics at Children’s Hospital of Philadelphia, said in a press release. “Clinicians can help their patients find ways of improving their health by helping them quit smoking in a nonjudgmental way.”
Background and methodology
Despite evidence-based tobacco treatment having been shown to have a positive effect on quality of life and survival among patients with cancer, cancer centers rarely engage with patients on this topic, according to researchers.
Researchers conducted a four-arm, cluster-randomized pragmatic trial at 11 clinical sites to compare the effect of behavioral economics-informed strategies to increase tobacco use treatment engagement during oncology encounters with patients with cancer.
Researchers provided EHR-based nudges promoting tobacco use treatment among four nudge conditions — patient only, clinician only, patient and clinician, or usual care.
The investigators randomly assigned 246 clinicians in 95 clusters, collecting tobacco use treatment penetration data from their encounters with 2,146 eligible patients who received oncologic care and smoked from June 2021 to July 2022.
Tobacco use treatment penetration, which researchers defined as “the proportion of patients with documented tobacco use treatment referral or a medication proscription in the EHR,” served as the primary outcome.
Results, next steps
Intent-to-treat analysis revealed that the clinician nudge led to a substantial increase in tobacco use treatment penetration when compared with usual care (35.6% vs. 13.5%; OR = 3.64, 95% CI, 2.52-5.24). Computer-only analysis showed a similar result (37.7% vs. 13.5%; OR = 3.77, 95% CI, 2.73-5.19).
Researchers noted that physicians appeared less likely than advanced practice providers to provide tobacco use treatment (intent-to-treat OR = 0.67; 95% CI, 0.51-0.88).
“This study shows that a behavioral economics ‘nudge’ strategy can increase tobacco use treatment in the oncology setting, which we hope will help more patients with cancer control their tobacco dependence and enjoy better cancer care outcomes,” Frank T. Leone, MD, MS, director of the comprehensive smoking treatment program at Penn Medicine and professor of pulmonary medicine in Perelman School of Medicine at the University of Pennsylvania, said in the release. “We look forward to continuing to build on this research and further increase engagement with tobacco use treatment in the oncology setting.”
References:
- Jenssen BP, et al. J Clin Oncol. 2023;doi:10.1200/JCO.23.00355.
- Penn and CHOP researchers find behavioral economics strategies can help patients quit smoking after a cancer diagnosis (press release). Available at: https://www.pennmedicine.org/news/news-releases/2023/july/behavioral-economics-strategies-help-cancer-patients-quit-smoking. Published July 19, 2023. Accessed July 25, 2023.
Collapse
Read more about
Click Here to Manage Email Alerts