DESCRIPTION (Applicant's Description) Home care is becoming central to the
delivery of health services within managed care. The Visiting Nurse
Association (VNA) provides a new channel for the delivery of behavioral
medicine interventions for cancer prevention and control. The specific aim
of this study is to train VNA nurses to provide their patients who smoke
with brief and effective state-of-the-art smoking cessation interventions.
A key feature of this proposal is that it takes a public health approach in
proactively reaching a patient population who may not otherwise have access
to, (or spontaneously seek) treatment. We chose smoking because it remains
the leading preventable addictive behavior responsible for chronic disease
morbidity and mortality, especially cancer. Older smokers may require
motivational enhancement before deciding to quit, given that they have
difficulty personalizing health risks and focusing on the benefits of
quitting. We propose to randomize and train home health care nurses (N=104)
to deliver one of two smoking cessation interventions to their patients over
the course of three visits: A Motivational Enhancement (ME) condition
(e.g., motivational techniques tailored to the patient's readiness to change
and physiological feedback), or a Self-Help (SH) condition (brief advice to
quit). Nurses in both groups will receive the new Agency for Health Care
Policy and Research (AHCPR) guidelines for smoking cessation, and provide
their patients with age-matched smoking cessation manuals. In contrast to
the SH group, nurses in the ME group will receive specialized training on
motivating smokers to quit. Our primary hypotheses are that the ME
intervention will outperform the SH condition on number of quit attempts,
greater likelihood of abstinence at 12 months post-treatment, and change in
readiness to quit. We will be closely collaborating with VNA nurses at all
organizational levels to develop nurse training, facilitate intervention
delivery, and ensure quality control.
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