The Breaking Addiction to Tobacco for Health 2 (BREATHE 2) study continues to help patients at participating health systems who smoke explore their individual journey with tobacco.
Participants in the BREATHE 2 Cessation project have certainly appreciated it. More than 92 percent of participants said they very often or always felt that their quit coach appreciated them. In addition, more than 88 percent said they very often or always agreed with their quit coaches on the methods they would use to reduce their tobacco use. Anecdotally, patients express how much they adore their quit coaches.
Milwaukee Health Counselor TJay Christenson shared thoughts on why. “We don’t lecture or judge them, which unfortunately I think a lot of people who smoke are used to,” he said. “The counseling we do with patients empowers them, we’re just there as a guide as opposed to just telling them what to do. We work through things together.”
“Our seasoned health counselors have done a great job keeping participants engaged for the duration of the study,” said Clinical Research Manager Meg Feyen, “not an easy feat when dealing with something as challenging as quitting smoking.”
“It helps that my colleagues and I have been doing this for a long time,” Christenson said, “and have worked with a variety of participants. We’re fortunate to have a team of empathetic health counselors. We’ve all heard a lot about the challenges that come along with making this life change and understand that it’s difficult.”
Madison Health Counselor Kathleen Cantu said the treatment option to change their smoking patterns (rather than committing to fully quitting) has been new to many participants. Some gave it a try, gained confidence, and decided to fully quit, she said. They appreciated the new way to approach it, and especially enjoyed going at their own pace, feeling respected, in control of their decisions, and not pressured, Cantu said.
BREATHE 2 staff have reached out to more than 13,000 patients who smoke at two health systems—Advocate Aurora Health and UW Health. More than 2,000 patients initially agreed to consider quitting smoking, and 481 enrolled in the BREATHE 2 Cessation study.
For the 607 patients not ready to quit but willing to discuss their journey with tobacco further, 229 have consented and enrolled in the BREATHE 2 Comprehensive Chronic Care (3C) study. In this study, the health counselors work with the participants at their pace, based on their goals for their smoking.
It’s thanks to hard work by the entire study team, said UW-CTRI Research Director and BREATHE 2 Cessation study leader Dr. Megan Piper. “The tobacco care managers from the healthcare systems have been absolutely fantastic in their commitment to helping primary care patients who smoke engage in evidence-based cessation treatment,” Piper said.
“Our health counselors (quit coaches) have been amazing at giving these patients the best possible chances of quitting through their knowledgeable and supportive counseling. These teams have also had to be flexible and step up to the plate to cover calls for each other, help with getting out thousands of mailings, and sustain their high level of performance throughout the pandemic.”
“Health Counselors have also stepped up to help now, more than ever, with follow-up calls and are willing to do what it takes to keep this study moving along,” Feyen said. “Together, they have really accomplished a lot in the past two years.”
Christenson said that using combination medications and taking medication before the quit-smoking date have been novel strategies for many participants. “I’ve had several participants mention that it’s not something they would have thought to do on their own, and feel it might be the difference they needed in order to be successful.”
“We definitely would not be able to answer these kinds of sophisticated research questions,” Piper said, “questions that have the potential to change real-world clinical practices, without our quit coaches’ commitment and expertise.”
The BREATHE 2 3C study has enrolled 88.6% of the target 1000 participants. Part of the study’s recruitment success is due to a strategy called Incentivized Outreach. It involves sending a postcard which offers a small incentive to call their healthcare clinic to learn about smoking treatment options for people who smoke—including those not ready to quit.
“The postcards are a great way of getting people with at least some interest in learning about treatment options to come to us,” said UW-CTRI Director of Veterans Research and leader of the BREATHE2 3C study Dr. Jessica Cook. “Another upside is that, after participants call and enroll in the study, we’ve had a high percentage of people enroll in smoking treatment.”
Cook said the tobacco care managers are doing an incredible job fielding hundreds of calls, informing patients about their options, and enrolling them in the study. “And the health counselors are doing a top-notch job treating participants for their tobacco use once they enter the study.”
UW-CTRI Director of Implementation and Health Services Research, Danielle McCarthy, PhD, noted that the efforts of the entire BREATHE 2 team at UW-CTRI, UW Health, and Aurora Health help to empower patients to make choices about smoking treatment, and this has potential to improve health equity and health outcomes for patients.
“The BREATHE 2 team has informed thousands of patients who smoke about their smoking treatment options through the Wisconsin Tobacco Quit Line, their primary care providers, and the innovative BREATHE 2 studies. One of the things we will learn from BREATHE 2 is how to effectively, efficiently, and equitably engage people in smoking treatment. We could not do this work without the invaluable contributions of all our BREATHE 2 team members, and our partners at UW Health and Aurora Health, including our stellar team of tobacco care managers.”