Feasibility and Pilot Efficacy of a Brief Smoking Cessation Intervention Delivered by Vascular Surgeons in the Vascular Physician Offer and Report (VAPOR) Trial

Published in: Journal of Vascular Surgery, [Epub February 2017], doi 10.1016/j.jvs.2016.10.121

Posted on RAND.org on February 09, 2017

by Philip Goodney, Emily Spangler, Karina Newhall, Benjamin S. Brooke, Andres Schanzer, Tze-Woei Tan, Adam W. Beck, John H. Hallett, Todd A. MacKenzie, Maria Orlando Edelen, Andrew W. Hoel, Nancy A. Rigotti, Alik Farber

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Research Question

  1. Is it feasible to have surgeons deliver an intervention to get patients with peripheral arterial disease to quit smoking?

Background

This study determined the feasibility and potential efficacy of an evidence-based standardized smoking cessation intervention delivered by vascular surgeons to smokers with peripheral arterial disease.

Methods

We performed a cluster-randomized trial of current adult smokers referred to eight vascular surgery practices from September 1, 2014, to July 31, 2015. A three-component smoking cessation intervention (physician advice, nicotine replacement therapy, and telephone-based quitline referral) was compared with usual care. The primary outcome was smoking cessation for 7 days, assessed 3 months after the intervention. Secondary outcomes were patients' nicotine dependence and health expectancies of smoking assessed using Patient Reported Outcomes Measurement Information System (PROMIS; RAND Corporation, Santa Monica, Calif).

Results

We enrolled 156 patients (65 in four intervention practices, 91 in four control practices), and 141 (90.3%) completed follow-up. Patients in the intervention and control practices were similar in age (mean, 61 years), sex (68% male), cigarettes per day (mean, 14), and prior quit attempts (77%). All three components of the intervention were delivered to 75% of patients in intervention practices vs to 7% of patients at control practices (P < .001). At 3 months, 23 of 57 patients (40.3%) in the intervention group quit smoking (23 of 56 patients quit who completed follow-up, plus 1 death included in the analysis in the denominator as a smoker), and 26 of 84 patients (30.9%) In the control group quit smoking (26 patients of 84 who completed follow-up, including 2 deaths included in the denominator as smokers). This difference (40.3% quit rate in intervention, 31% quit rate in control; P = .250) was not statistically significant in crude analyses (P = .250) or analyses adjusted for clustering (P = .470). Multivariable analysis showed factors associated with smoking cessation were receipt of physician advice (odds ratio for cessation, 1.96; 95% confidence interval, 1.28-3.02; P < .002) and nicotine replacement therapy (odds ratio, 1.92; 95% confidence interval, 1.43-2.56; P < .001).

Conclusions

Implementation of a brief, surgeon-delivered smoking cessation intervention is feasible for patients with peripheral arterial disease. A larger trial will be necessary to determine whether this is effective for smoking cessation.

Key Findings

  • Three-quarters of patients in the intervention group received all three components of the intervention, suggesting that it is feasible to integrate smoking cessation effectively into a surgical workflow.
  • Patients in the intervention group did not quit smoking at a significantly higher rate than patients in the control group.
  • Patients most likely to quit smoking were those who received advice from physicians and support on nicotine replacement therapy.

Research conducted by

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