Cluster Randomized Pragmatic Clinical Trial Testing Behavioral Economic Implementation Strategies to Improve Tobacco Treatment for Patients With Cancer Who Smoke
Brian P. Jenssen, Robert A. Schnoll, Rinad S. Beidas, Justin E. Bekelman, Anna‐Marika Bauer, Sarah Evers‐Casey, Tierney Fisher, Callie A. Scott, Jody Nicoloso, Peter Gabriel, David A. Asch, Alison M. Buttenheim, Jessica Chen, J Soto Melo, Dwayne Grant, Michael Horst, Randall A. Oyer, Lawrence N. Shulman, Alicia B. W. Clifton, Adina Lieberman, Tasnim Salam, Katharine A. Rendle, Krisda H. Chaiyachati, Rachel C. Shelton, Oluwadamilola M. Fayanju, E. Paul Wileyto, Sue Ware, Daniel Blumenthal, Daniel Ragusano, Frank T. Leone
Abstract
PURPOSE: Few cancer centers systematically engage patients with evidence-based tobacco treatment despite its positive effect on quality of life and survival. Implementation strategies directed at patients, clinicians, or both may increase tobacco use treatment (TUT) within oncology. METHODS: We conducted a four-arm cluster-randomized pragmatic trial across 11 clinical sites comparing the effect of strategies informed by behavioral economics on TUT engagement during oncology encounters with cancer patients. We delivered electronic health record (EHR)-based nudges promoting TUT across four nudge conditions: patient only, clinician only, patient and clinician, or usual care. Nudges were designed to counteract cognitive biases that reduce TUT engagement. The primary outcome was TUT penetration, defined as the proportion of patients with documented TUT referral or a medication prescription in the EHR. Generalized estimating equations were used to estimate the parameters of a linear model. RESULTS: = .004). CONCLUSION: EHR nudges, informed by behavioral economics and aimed at oncology clinicians, appear to substantially increase TUT penetration. Adding patient nudges to the implementation strategy did not affect TUT penetration rates.