Study Descriptions

Evaluating a Risk Communication Intervention for Veterans Receiving Cancer Care

PI: Paul Krebs, PhD

The overall purpose of the project is to develop and test a risk communication tool (4-page information sheet) designed to increase tobacco-dependent cancer patients’ motivation to quit among and to link them to effective tobacco treatment. The first stage of the research involved conducting 20 cognitive interviews to gain patient feedback on a draft version of the risk communication tool to improve its effectiveness, readability, and comprehension. In the current stage, we will test the utility of the risk communication tool on patient interest in seeking tobacco treatment and quit rates.

Million Veteran Program: A Partnership with Veterans (MVP)

Site PI: Scott Sherman, MD, MPH

MVP is a national, voluntary research program funded entirely by the Department of Veterans Affairs Office of Research & Development. The goal of MVP is to partner with Veterans receiving their care in the VA Healthcare System to study how genes affect health. To do this, MVP will build one of the world's largest medical databases by safely collecting blood samples and health information from one million veteran volunteers. Data collected from MVP will be stored anonymously for research on diseases like diabetes and cancer, and military-related illnesses, such as post-traumatic stress disorder.

Proactive Care Coordination for Cancer Survivors who Smoke (PROCESS)

PIs: Paul Krebs, PhD and Erin Rogers, MPH

Tobacco use among patients diagnosed with cancer negatively impacts treatment, survival, and quality of life outcomes. The majority of patients who smoke continue to do so following diagnosis, yet oncology providers generally do not educate patients and refer them to tobacco treatment. In this study funded by the Centers for Disease Control (CDC), we are conducting a randomized controlled trial that will test the population impact of, and satisfaction with, two methods for coordinating tobacco treatment for cancer survivors. Results will directly inform decision-making and clinical care models for tobacco treatment in oncology care.

Proactive Outreach to Smokers in VA Mental Health (ProMH)

PIs: Scott Sherman, MD, MPH and Steven Fu, MD, MSCE

Persons with a mental health diagnosis are 2-4 times more likely to smoke than the general population and face many barriers to quitting. ProMH is a 4-site, randomized controlled trial testing the effectiveness of a proactive approach to engaging VA mental health patients into smoking cessation treatment.

We use the EMR to identify smokers with a recent mental health clinic visit. We select a sample of these smokers and randomize them to usual care or intervention. Patients in the intervention are called by a counselor who uses a motivational interviewing approach to engage the patients into smoking cessation counseling. Our study staff also arrange for these patients to receive cessation medications.

We are testing the effectiveness of this approach on two primary outcomes: 1) treatment engagement and 2) biochemically validated abstinence at 12 months.

A Randomized Comparative Effectiveness Trial of Financial Incentives Versus Usual Care for Smokers Hospitalized in the Veterans Affairs Hospital System (FIESTA)

PI: Joseph Ladapo, MD

We are conducting a randomized trial evaluating the impact of financial incentives to motivate use of evidence-based smoking cessation treatment and abstinence. Our objective is to compare the impact of financial incentives on a participant’s smoking abstinence, their use of evidenced-based therapy, and their quality of life. We will enroll 182 hospitalized smokers from all inpatient units at the Manhattan VA. During hospitalization, all patients will receive usual care: 1) screening, 2) brief counseling by the RN and/or MD and 3) access to nicotine replacement therapy (NRT). All study patients will be referred to receive brief counseling from the state quitline. The intervention group will receive financial incentives for utilization of evidence-based treatment (counseling + NRT) and for biochemically verified abstinence at 2 months and 6 months. The primary outcome is smoking abstinence at 6-month follow-up. We hope to estimate the short-term and long-term return on investment of using financial incentives to promote smoking cessation.