Article

A Decision Aid to Improve Smoking Abstinence for Families Facing Cancer

Karen K. McDonnell

Linda F. C. Bullock

Benjamin D. Kozower

Patricia Hollen

Janie Heath

Virginia Rovnyak

thoracic neoplasms, decision aid, tobacco use cessation, family intervention, dyads
ONF 2014, 41(6), 649-658. DOI: 10.1188/14.ONF.649-658

Purpose/Objectives: To test the feasibility of a multidisciplinary, multicomponent, theory-based decision aid.

Design: Prospective, one-group repeated measures.

Setting: Thoracic surgery clinic in a university hospital cancer center in central Virginia.

Sample: 8 dyads, consisting of 16 total participants.

Methods: A multidisciplinary, multicomponent smoking cessation intervention incorporated a theory-based decision aid. Enrollment occurred preoperatively; four face-to-face visits and an exit interview were conducted during six months.

Main Research Variables: Feasibility was evaluated based on four criteria: recruitment, retention, adherence, and acceptability.

Findings: The recruitment rate was 44%, and the retention rate was 100%. Adherence to the intervention and the acceptability of the decision aid were greater for patients than family members. Patients had greater abstinence than family members before surgery and at six months. Exit interview themes included (a) preoperative timing was acceptable and (b) involving household members who smoke was important.

Conclusions: Recruiting male patients and their female partners is feasible. Participants liked convenience, autonomy, and a family approach. Family members wanted more control over cessation timing and a more intensive approach to weight and mental health management. Successful dyads worked together to maintain abstinence.

Implications for Nursing: Oncology nurses can assess patients' and family members' smoking status, facilitate understanding about specific benefits of smoking cessation and the obstacle posed by household smokers, and make referrals to expert resources. Encouraging smoke-free environments is an important step toward reducing secondhand smoke exposure and promoting cessation.

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    References

    Bastian, L. A., Fish, L. J., Peterson, B. L., Biddle, A. K., Garst, J., Lyna, P., … McBride, C. M. (2011). Proactive recruitment of cancer patients' social networks into a smoking cessation trial. Contemporary Clinical Trials, 32, 498-504. doi:10.1016/j.cct.2011.03.006
    Bottorff, J. L., Robinson, C. A., Sullivan, K. M., & Smith, M. L. (2009). Continued family smoking after lung cancer diagnosis: The patient's perspective [Online exclusive]. Oncology Nursing Forum, 36, E126-E132. doi:10.1188/09.ONF.E126-E132
    Browman, G. P., Mohide, E. A., Willan, A., Hodson, I., Wong, G., Grimard, L., … Farrell, S. (2002). Association between smoking during radiotherapy and prognosis in head and neck cancer: A follow-up study. Head and Neck, 24, 1031-1037. doi:10.1002/hed.10168
    Cataldo, J. K., Dubey, S., & Prochaska, J. J. (2010). Smoking cessation: An integral part of lung cancer treatment. Oncology, 78, 289-301. doi:10.1159/000319937
    Coday, M., Boutin-Foster, C., Goldman Sher, T., Tennant, J., Greaney, M. L., Saunders, S. D., … Somes, G. W. (2005). Strategies for retaining study participants in behavioral intervention trials: Retention experiences of the NIH Behavior Change Consortium. Annals of Behavioral Medicine, 29(Suppl.), 55-65.
    Cooley, M. E., Sarna, L., Brown, J. K., Williams, R. D., Chernecky, C., Padilla, G., & Danao, L. L. (2003). Challenges of recruitment and retention in multisite clinical research. Cancer Nursing, 26, 376-384. doi:10.1097/00002820-200310000-00006
    Cooley, M. E., Sarna, L., Brown, J. K., Williams, R. D., Chernecky, C., Padilla, G., … Elashoff, D. (2007). Tobacco use in women with lung cancer. Annals of Behavioral Medicine, 33, 242-250. doi:10.1007/BF02879906
    Cooley, M. E., Sarna, L., Kotlerman, J., Lukanich, J. M., Jaklitsch, M., Green, S. B., & Bueno, R. (2009). Smoking cessation is challenging even for patients recovering from lung cancer surgery with curative intent. Lung Cancer, 66, 218-225. doi:10.1016/j.lungcan.2009.01.021
    Dresler, C. M., & Gritz, E. R. (2001). Smoking, smoking cessation and the oncologist. Lung Cancer, 34, 315-323. doi:10.1016/S0169-5002(01)00333-6
    Epstein, N., Baldwin, L., & Bishop, D. (1983). The McMaster Family Assessment Device. Journal of Marital and Family Therapy, 9, 171-180. doi:10.1111/j.1752-0606.1983.tb01497.x
    Falba, T. A., & Sindelar, J. L. (2008). Spousal concordance in health behavior change. Health Services Research, 43, 96-116. doi:10.1111/j.1475-6773.2007.00754.x
    Fiore, M. C., Jaén, C. R., Baker, T. B., Bailey, W. C., Benowitz, N. L., Curry, S. J., … Wewers, M. E. (2008). Treating tobacco use and dependence: 2008 update. Retrieved from http://bphc.hrsa.gov/buckets/treatingtobacco.pdf
    Franks, M. M., Pienta, A. M., & Wray, L. A. (2002). It takes two: Marriage and smoking cessation in the middle years. Journal of Aging and Health, 14, 336-354. doi:10.1177/08964302014003002
    Gritz, E. R., Nisenbaum, R., Elashoff, R. E., & Holmes, E. C. (1991). Smoking behavior following diagnosis in patients with stage I non-small cell lung cancer. Cancer Causes and Control, 2, 105-112.
    Hansen, S. (2014). My thought coach: A Stin project. Retrieved from http://www.mythoughtcoach.com
    Heatherton, T. F., Kozlowski, L. T., Frecker, R. C., & Fagerström, K. O. (1991). The Fagerström Test for Nicotine Dependence: A revision of the Fagerström Tolerance Questionnaire. British Journal of Addiction, 86, 1119-1127. doi:10.1111/j.1360-0443.1991.tb01879.x
    Hollen, P. J. (1994). Psychometric properties of two instruments to measure quality decision making. Research in Nursing and Health, 17, 137-148.
    Hollen, P. J. (2005). Decision-making guide: Theory of better decision making [CD]. Charlottesville, VA: Author.
    Hollen, P. J., Gralla, R. J., Jones, R. A., Thomas, C. Y., Brenin, D. R., Weiss, G. R., … Petroni, G. R. (2013). A theory-based decision aid for patients with cancer: Results of feasibility and acceptability testing of DecisionKEYS for cancer. Supportive Care in Cancer, 21, 889-899. doi:10.1007/s00520-012-1603-8
    Hurt, R. D., Ebbert, J. O., Hays, J. T., & McFadden, D. D. (2009). Treating tobacco dependence in a medical setting. CA: Cancer Journal for Clinicians, 59, 314-326. doi:10.3322/caac.20031
    Janis, I. L., & Mann, L. (1981). A theoretical framework for decision making. In I. L. Janis (Ed.), Counseling on personal decisions: Theory and research on short-term helping relationships (pp. 47-72). New Haven, CT: Yale University Press.
    Jones, R. A., Steeves, R., Ropka, M. E., & Hollen, P. (2013). Capturing treatment decision making among patients with solid tumors and their caregivers [Online exclusive]. Oncology Nursing Forum, 40, E24-E31. doi:10.1188/13.ONF.E24-E31
    Kozower, B. D., Lau, C. L., Phillips, J. V., Burks, S. G., Jones, D. R., & Stukenborg, G. J. (2010). A thoracic surgeon-directed tobacco cessation intervention. Annals of Thoracic Surgery, 89, 926-930. doi:10.1016/j.athoracsur.2009.12.046
    Kroon, L. A. (2007). Drug interactions with smoking. American Journal of Health-System Pharmacy, 64, 1917-1921. doi:10.2146/ajhp060414
    Lengacher, C. A., Gonzalez, L. L., Giuliano, R., Bennett, M. P., Cox, C. E., & Reintgen, D. S. (2001). The process of clinical trials: A model for successful clinical trial participation. Oncology Nursing Forum, 28, 1115-1120.
    Luftman, V., Martin, C. A., Guenthner, G., Arnold, S. M., Mullett, T. W., & Jhaveri, M. (2011). The power of videotaped personal statements of patients with lung cancer: A recruitment strategy for smoking prevention and cessation programs. Oncology Nursing Forum, 38, 11-14. doi:10.1188/11.ONF.11-14
    Mason, D. P., Subramanian, S., Nowicki, E. R., Grab, J. D., Murthy, S. C., Rice, T. W., … Blackstone, E. H. (2009). Impact of smoking cessation before resection of lung cancer: A Society of Thoracic Surgeons General Thoracic Surgery Database study. Annals of Thoracic Surgery, 88, 362-371. doi:10.1016/j.athoracsur.2009.04.035
    Mayo Clinic. (2009). Medications to help you stop using tobacco™. Rochester, MN: Mayo Foundation for Medical Education and Research.
    Mayo Clinic. (2009). Smoke-free and living it™. Rochester, MN: Mayo Foundation for Medical Education and Research.
    McAlister, A. L., Perry, C. L., & Parcel, G. S. (2008). How individuals, environments, and health behaviors interact: Social cognitive theory. In K. Glanz, B. K. Rimer, K. Viswanath (Eds.), Health behavior and health education: Theory, research, and practice (4th ed., pp. 169-188). San Francisco, CA: Jossey-Bass.
    McBride, C. M., & Ostroff, J. S. (2003). Teachable moments for promoting smoking cessation: The context of cancer care and survivorship. Cancer Control, 10, 325-333.
    McCorkle, R., Packard, N., & Landenburger, K. (1984). Subject accrual and attrition: Problems and solutions. Journal of Psychosocial Oncology, 2, 137-146. doi:10.1300/J077v02n03_11
    McDonnell, K. K., Bullock, L. F., Hollen, P. J., Heath, J., & Kozower, B. D. (2014). Emerging issues on the impact of smoking on health-related quality of life in individuals with lung cancer and their families. Clinical Journal of Oncology Nursing, 18, 171-181. doi:10.1188/14.CJON.18-02AP
    Motzer, S. A., Moseley, J. R., & Lewis, F. M. (1997). Recruitment and retention of families in clinical trials with longitudinal designs. Western Journal of Nursing Research, 19, 314-333.
    Nayan, S., Gupta, M. K., Strychowsky, J. E., & Sommer, D. D. (2013). Smoking cessation interventions and cessation rates in the oncology population: An updated systematic review and meta-analysis. Otolaryngology-Head and Neck Surgery, 149, 200-211.
    Northouse, L., Kershaw, T., Mood, D., & Schafenacker, A. (2005). Effects of a family intervention on the quality of life of women with recurrent breast cancer and their family caregivers. Psycho-Oncology, 14, 478-491. doi:10.1002/pon.871
    Northouse, L. L., Rosset, T., Phillips, L., Mood, D., Schafenacker, A., & Kershaw, T. (2006). Research with families facing cancer: The challenges of accrual and retention. Research in Nursing and Health, 29, 199-211. doi:10.1002/nur.20128
    O'Brien, M. A., Whelan, T. J., Villasis-Keever, M., Gafni, A., Charles, C., Roberts, R., … Cai, W. (2009). Are cancer-related decision aids effective? A systematic review and meta-analysis. Journal of Clinical Oncology, 27, 974-985. doi:10.1200/JCO.2007.16.0101
    Park, E. R., Japuntich, S., Temel, J., Lanuti, M., Pandiscio, J., Hilgenberg, J., … Rigotti, N. A. (2011). A smoking cessation intervention for thoracic surgery and oncology clinics: A pilot trial. Journal of Thoracic Oncology, 6, 1059-1065. doi:10.1097/JTO.0b013e318215a4dc
    Parsons, A., Daley, A., Begh, R., & Aveyard, P. (2010). Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: Systematic review of observational studies with meta-analysis. BMJ, 340, b5569. doi:10.1136/bmj.b5569
    Quinn, C., Dunbar, S. B., Clark, P. C., & Strickland, O. L. (2010). Challenges and strategies of dyad research: Cardiovascular examples. Applied Nursing Research, 23, e15-e20. doi:10.1016/j.apnr.2008.10.001
    Robinson, C. A., Bottorff, J. L., Smith, M. L., & Sullivan, K. M. (2010). "Just because you've got lung cancer doesn't mean I will": Lung cancer, smoking, and family dynamics. Journal of Family Nursing, 16, 282-301. doi:10.1177/1074840710370747
    Santacroce, S. J., Maccarelli, L. M., & Grey, M. (2004). Intervention fidelity. Nursing Research, 53, 63-66.
    Sawin, K., & Harrigan, M. (1995). Well-established self-report instruments. In K. J. Sawin, M. P. Harrigan, & P. Woog (Eds.), Measures of family functioning for research and practice (pp. 1-50). New York, NY: Springer.
    Schilling, A. R., Conaway, M. R., Wingate, P. J., Atkins, J. N., Berkowitz, I. M., Clamon, G. H., … Vinciquerra, V. (1997). Recruiting cancer patients to participate in motivating their relatives to quit smoking. A cancer control study of the Cancer and Leukemia Group B (CALGB 9072). Cancer, 79, 152-160. doi:10.1002/(SICI)1097-0142(19970101)79:1<152::AID-CNCR22>3.0.CO;2-2
    Shields, M. (2007). Smoking bans: Influence on smoking prevalence. Health Reports, 18, 9-24.
    Shoham, V., Rohrbaugh, M. J., Trost, S. E., & Muramoto, M. (2006). A family consultation intervention for health-compromised smokers. Journal of Substance Abuse Treatment, 31, 395-402. doi:10.1016/j.jsat.2006.05.012
    Stacey, D., Samant, R., & Bennett, C. (2008). Decision making in oncology: A review of patient decision aids to support patient participation. CA: A Cancer Journal for Clinicians, 58, 293-304. doi:10.3322/CA.2008.0006
    Underwood, J. M., Townsend, J. S., Tai, E., White, A., Davis, S. P., & Fairley, T. L. (2012). Persistent cigarette smoking and other tobacco use after a tobacco-related cancer diagnosis. Journal of Cancer Survivorship, 6, 333-344. doi:10.1007/s11764-012-0230-1
    Waller, L. L., Weaver, K. E., Petty, W. J., & Miller, A. A. (2010). Effects of continued tobacco use during treatment of lung cancer. Expert Review of Anticancer Therapy, 10, 1569-1575. doi:10.1586/era.10.140
    Warren, G. W., Kasza, K. A., Reid, M. E., Cummings, K. M., & Marshall, J. R. (2013). Smoking at diagnosis and survival in cancer patients. International Journal of Cancer, 132, 401-410. doi:10.1002/ijc.27617