UW-CTRI is partnering with two health systems, Advocate Aurora Health and UW Health, to treat more than 4,000 clinic patients. Aurora doctors are excited about BREATHE 2’s promise.
BREATHE 2 Tobacco Care Managers, who work for the participating health systems, are reaching out to patients listed as smokers in electronic health records at participating clinics.
The study uses opt-out recruitment, meaning everyone will hear about the study from the Care Managers unless the patient tells us they don’t want to hear about it. BREATHE 2 offers treatment to all smokers at participating clinics. Tobacco Care Mangers play a pivotal role in BREATHE 2 research.
This study will investigate how best to match treatments to smokers, given their readiness to quit.
“We know the majority of smokers who visit primary care clinics want to quit; most of them have already tried and are often discouraged,” Fiore said. “But smoking remains the leading preventable cause of death and disease in America. We will be offering something for everyone. For those not ready to quit, this includes incentives, tailored outreach and, if they decide to quit later, state of the art medication and quitline coaching.”
BREATHE 2 will develop a chronic care quit-smoking treatment using factorial designs to develop the best treatments for all smokers. It will use the “RE-AIM” research constructs to translate these results into real-world healthcare changes. Here’s how:
- R: Increase Reach by using a more inclusive opt-out recruitment strategy to contact clinic patients and offer help.
- E: Augment treatment Effectiveness by optimizing intervention components that work especially well together for smokers who are ready to quit and those who are not.
- A: Bolster Adoption by developing the chronic-care program within two healthcare systems and using their patient populations, personnel, and resources (e.g., EHRs). Engineer the chronic-care program to produce benefits of great appeal to potential adopters (e.g., cost-effectiveness, little impact on clinic workflow).
- I: Foster Implementation potential by evaluating all potential chronic-care program components to ensure they are feasible with regard to cost, staffing needs, training required, and resource requirements.
- M: Finally, enhance Maintenance by developing treatments engineered to maintain patients’ behavior change and that are easy and inexpensive to continue by healthcare systems and staff.
- Project 1, Cessation Optimization Trial, led by Dr. Megan Piper, will yield two optimized treatments for smokers ready to quit.
- Project 2, Reach Optimization Trial, led by Dr. Danielle McCarthy, will create an optimized treatment for those not ready to quit.
- Project 3, Evaluation Project, led by Dr. Jess Cook, will evaluate a chronic-care treatment package comprising individually validated interventions for those unwilling to quit, to those ready to quit, to those recovering from an unsuccessful quit attempt.
- Project 4, Implementation Project, led by Dr. Robin Mermelstein and Dr. Danielle McCarthy, will identify key strategies to translate these results into real-world clinical practices.
Dr. Marlon Mundt, UW-CTRI researcher and health economist, will work on cost-effectiveness calculations.
Ultimately, BREATHE 2 should greatly expand the reach and effectiveness of smoking treatment in healthcare systems, meaningfully reduce smoking prevalence in healthcare populations, and thereby reduce cancer morbidity and mortality.