Impact of personalized biomedical risk assessment on smoking cessation counselling in chronic obstructive pulmonary...

Smoking cessation reduces mortality and improves quality of life in chronic obstructive pulmonary disease (COPD). Brief physician counselling is effective for smoking cessation, but counselling is often not provided. We designed a personalized biomedical risk assessment infographic depicting predicted future lung function decline and corresponding clinical consequences occurring with versus without smoking cessation, to trigger and facilitate smoking cessation counselling at the point-of-care. Herein, we determined feasibility of its real-world implementation and impact on care.

This was a feasibility study of usual care (pre-intervention period) (year 1) followed by the infographic (intervention period) (year 2), at a tertiary care center (St. Michael's Hospital - SMH, University of Toronto). We recruited pulmonologists and primary care providers who refer patients to the SMH pulmonary function laboratory (PFL). Current smokers with COPD referred for spirometry by consenting providers were provided with the infographic through the PFL software, with instructions to bring this to their provider for discussion. Co-primary behavioural outcomes measured through e-chart review were: changes in the proportion of visits in which patients (1) received smoking cessation counseling; and (2) were prescribed/recommended smoking cessation pharmacotherapy.

There were 87 (median age 66.0 years; 60.0% male) and 104 (67.5 years; 63.0% male) eligible patients in the pre-intervention and intervention periods, respectively. Smoking cessation counselling was delivered in 58/86 (67.4%) versus 96/119 (80.7%) eligible visits (p = 0.045) and smoking cessation pharmacotherapy in 10/86 (11.6%) versus 22/119 (18.5%) visits (p = 0.25) in the pre-intervention period and intervention period, respectively. Changes in respiratory medications were more common in the intervention period (33.6%) compared to the pre-intervention period (22.6%) (p < 0.001). These changes were seen despite successful delivery of the infographic in only 60/119 (50.4%) eligible visits. Provider feedback was highly favorable.

Despite an intervention fidelity of only 50%, our study suggests that a personalized biomedical risk assessment infographic increases smoking cessation counselling rates and may alter COPD management. Generation of the infographic should be automated to improve delivery, and the intervention should then be evaluated for its impact on smoking cessation.

The study was registered on October 7^th 2019 at ClinicalTrials.gov (NCT04119934).