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Evaluation of an Electronic Decision Aid to Enhance Clinical Discussions on Smoking Cessation in Primary Care Settings

Lindsay Player Henry, Scott M. Strayer, MD, MPH, Tyler Dorman, MPH, Christy Kollath-Cattano, PhD, Ramzi Salloum, PhD, Martin Durkin, MD, MPH, MAS, Drew Albano, MD, Meenu Jindal, MD,  James F. Thrasher, PhD

Context: Smokers are more likely to use e-cigarettes to help them quit smoking vs. FDA-approved medications or counseling. Physicians increasingly report having to address e-cigarettes with their patients who smoke; yet, report discomfort discussing them given uncertainties around their potential harm and efficacy for smoking cessation. 
Objective: Develop and evaluate an electronic smoking cessation counseling decision aid (DA) that includes current recommendations and e-cigarette information to encourage and enhance clinical discussions about smoking cessation. 
Population and Setting: Patients who smoke (N=92 usual care; 90 with DA) and their physicians (N≈75) in academic primary care clinics in South Carolina (N=3; 2 Family Medicine and 1 Internal Medicine).
Intervention/Instrument: We developed a DA that included information on e-cigarettes only for current smokers who also used e-cigarettes and for those not willing to quit combustible cigarette smoking. The DA also included information about FDA-approved medications for smokers willing to quit, whether they used e-cigarettes or not. 
Results: Usability testing with smokers indicated strong acceptance of the DA. More participants in the DA group reported being asked if they were ready to quit smoking (89% vs. 67%, p=0.001) and discussing methods to quit (81% vs. 48%, p<0.001). Smokers in the DA group had significantly higher odds of discussing the specific methods of nicotine replacement therapy (54% vs. 26%, p<0.001) and prescription medications (26% vs. 12%, p=0.03). There were no significant differences between the two groups in likelihood of discussing other smoking cessation methods, including e-cigarettes (19% vs. 16%, p=NS). Counseling quality was measured based on overall satisfaction, communication satisfaction and decisional conflict. Among smokers who were asked if they were ready to quit smoking, the median score for overall satisfaction was significantly higher in the decision aid group than the usual care group (4.7 vs. 4.0, p=0.032).  
Conclusion: The decision aid led to increased counseling by primary care physicians regarding recommended smoking cessation treatments. Overall patient satisfaction with counseling was improved compared with usual care. 

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