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PRCHN Associate Director Sue Flocke, PhD, Awarded Smoking Cessation Study Grant
PRCHN Associate Director Sue Flocke, PhD, Awarded Smoking Cessation Study GrantA study team lead by PRCHN Associate Director Sue Flocke, PhD, received $2 million from the Patient-Centered Outcomes Research Institute (PCORI) to study a combination approach to help patients stop smoking, particularly those who are socially and economically disadvantaged. The project involves partnership with faculty and staff at MetroHealth Medical Center, the Ohio Department of Health and National Jewish Health, the Quitline providers for Ohio. The study will try to determine whether pairing the Teachable Moment Communication Process (TMCP) with the Ask-Advise-Connect (AAC) strategy will increase smoking cessation outcomes.

The AAC approach focuses on a systems-based strategy for identifying the smoking status of patients, providing brief advice, and offering a referral to the Quitline, a hotline staffed by professionals trained in smoking cessation counseling. This study will implement changes in the electronic health record to allow an electronic referral so that patients who want smoking cessation assistance are contacted proactively by the Quitline. TMCP uses a communication strategy developed by Flocke’s team that incorporates the patient’s concerns into a clinician partnership-oriented discussion about stopping tobacco use.

The problem with AAC alone is that many patients referred to the Quitline are not ready to stop smoking but may feel obligated to accept the referral to the hotline from their primary care team. In prior studies, less than 50 percent of patients who agreed to be referred to Quitline were successfully contacted by its counselors. However, among those who are contacted, enrollment and engagement in counseling services are good and have a positive effect on cessation attempts.

By combining TMCP with AAC, the goal is to increase the numbers of patients referred to Quitline who are truly committed to smoking cessation and therefore more likely to enroll and benefit from tailored counseling. Investigators will pay particular attention to improving how smoking cessation advice and assistance are delivered to socially and economically disadvantaged patients.
The CWRU research team led by Dr. Flocke will conduct a randomized trial of the TMCP and AAC combination in eight clinics serving more than 25,000 patients who smoke. Data will be collected through patient surveys, electronic health records, and Quitline participation. The study will also include in-depth interviews with subgroups of patients to learn ways to improve their referral to the Quitline.

Dr. Flocke notes: “Research has shown that economically and socially disadvantaged individuals are more likely to smoke and less likely to use smoking cessation services. With our research, we plan to systematically create linkages between primary care clinics and community resources to increase smoking cessation services to those people who are least likely to access them.”

Funding agency PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers, and clinicians with the evidence-based information needed to make better-informed healthcare decisions.