Download PDF
Appl Clin Inform 2023; 14(03): 439-447
DOI: 10.1055/a-2062-9627
Research Article

A Clinical Decision Support System for Motivational Messaging and Tobacco Cessation Treatment for Parents: Pilot Evaluation of Use and Acceptance

Brian P. Jenssen
1   Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
2   Clinical Futures, PolicyLab, and The Possibilities Project, Children's Hospital of Philadelphia, Pennsilvania, United States
3   Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
Shannon Kelleher
2   Clinical Futures, PolicyLab, and The Possibilities Project, Children's Hospital of Philadelphia, Pennsilvania, United States
,
Dean J. Karavite
3   Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
Ekaterina Nekrasova
2   Clinical Futures, PolicyLab, and The Possibilities Project, Children's Hospital of Philadelphia, Pennsilvania, United States
,
Jeritt G. Thayer
3   Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
Raj Ratwani
4   MedStar Health National Center for Human Factors in Healthcare, Washington, District of Columbia, United States
,
Judy A. Shea
5   Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Emara Nabi-Burza
6   Division of General Academic Pediatrics, Tobacco Research and Treatment Center, Massachusetts General Hospital for Children, Boston, Massachusetts, United States
,
Jeremy E. Drehmer
6   Division of General Academic Pediatrics, Tobacco Research and Treatment Center, Massachusetts General Hospital for Children, Boston, Massachusetts, United States
,
Jonathan P. Winickoff
6   Division of General Academic Pediatrics, Tobacco Research and Treatment Center, Massachusetts General Hospital for Children, Boston, Massachusetts, United States
,
Robert W. Grundmeier
1   Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
3   Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
Robert A. Schnoll
7   Department of Psychiatry, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Alexander G. Fiks
1   Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
2   Clinical Futures, PolicyLab, and The Possibilities Project, Children's Hospital of Philadelphia, Pennsilvania, United States
3   Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
› Author Affiliations Funding This study was supported by the U.S. Department of Health and Human Services; the National Institutes of Health; the National Cancer Institute (K08 CA226390-01).
› Further Information
    Permissions and Reprints

Abstract

Background Research is needed to identify how clinical decision support (CDS) systems can support communication about and engagement with tobacco use treatment in pediatric settings for parents who smoke. We developed a CDS system that identifies parents who smoke, delivers motivational messages to start treatment, connects parents to treatment, and supports pediatrician–parent discussion.

Objective The objective of this study is to assess the performance of this system in clinical practice, including receipt of motivational messages and tobacco use treatment acceptance rates.

Methods The system was evaluated at one large pediatric practice through a single-arm pilot study from June to November 2021. We collected data on the performance of the CDS system for all parents. Additionally, we surveyed a sample of parents immediately after the clinical encounter who used the system and reported smoking. Measures were: (1) the parent remembered the motivational message, (2) the pediatrician reinforced the message, and (3) treatment acceptance rates. Treatments included nicotine replacement therapy, quitline referral (phone counseling), and/or SmokefreeTXT referral (text message counseling). We described survey response rates overall and with 95% confidence intervals (CIs).

Results During the entire study period, 8,488 parents completed use of the CDS: 9.3% (n = 786) reported smoking and 48.2% (n = 379) accepted at least one treatment. A total of 102 parents who smoke who used the system were approached to survey 100 parents (98% response rate). Most parents self-identified as female (84%), aged 25 to 34 years (56%), and Black/African American (94%), and had children with Medicaid insurance (95%). Of parents surveyed, 54% accepted at least one treatment option. Most parents recalled the motivational message (79%; 95% CI: 71–87%), and 31% (95% CI: 19–44%) reported that the pediatrician reinforced the motivational message.

Conclusion A CDS system to support parental tobacco use treatment in pediatric primary care enhanced motivational messaging about smoking cessation and evidence-based treatment initiation.

Keywords

clinical decision support systems - smoking cessation - secondhand smoke - human-centered design - pediatrics

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed by the CHOP Institutional Review Board.




Publication History

Received: 19 December 2022

Accepted: 23 March 2023

Accepted Manuscript online:
27 March 2023

Article published online:
07 June 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 U.S. Department of Health and Human Services. The health consequences of smoking—50 years of progress: a report of the surgeon general,. 2014 . U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014. Accessed February 11, 2016 at: http://www.surgeongeneral.gov/library/reports/50-years-of-progress/
    PubMedGoogle Scholar
  • 2 Office on Smoking and Health (US). The health consequences of involuntary exposure to tobacco smoke: a report of the surgeon general. Centers for Disease Control and Prevention (US); 2006. Accessed February 11, 2016 at: http://www.ncbi.nlm.nih.gov/books/NBK44324/
    PubMedGoogle Scholar
  • 3 Tsai J, Homa DM, Gentzke AS. et al. Exposure to secondhand smoke among nonsmokers - United States, 1988-2014. MMWR Morb Mortal Wkly Rep 2018; 67 (48) 1342-1346
    CrossrefPubMedGoogle Scholar
  • 4 Jha P, Ramasundarahettige C, Landsman V. et al. 21st-century hazards of smoking and benefits of cessation in the United States. N Engl J Med 2013; 368 (04) 341-350
    CrossrefPubMedGoogle Scholar
  • 5 den Exter Blokland EAW, Engels RCME, Hale III WW, Meeus W, Willemsen MC. Lifetime parental smoking history and cessation and early adolescent smoking behavior. Prev Med 2004; 38 (03) 359-368
    CrossrefPubMedGoogle Scholar
  • 6 Rosen LJ, Noach MB, Winickoff JP, Hovell MF. Parental smoking cessation to protect young children: a systematic review and meta-analysis. Pediatrics 2012; 129 (01) 141-152
    CrossrefPubMedGoogle Scholar
  • 7 Farber HJ, Walley SC, Groner JA, Nelson KE. Section on Tobacco Control. Clinical practice policy to protect children from tobacco, nicotine, and tobacco smoke. Pediatrics 2015; 136 (05) 1008-1017
    CrossrefPubMedGoogle Scholar
  • 8 Winickoff JP, Nabi-Burza E, Chang Y. et al. Implementation of a parental tobacco control intervention in pediatric practice. Pediatrics 2013; 132 (01) 109-117
    CrossrefPubMedGoogle Scholar
  • 9 Daly JB, Mackenzie LJ, Freund M, Wolfenden L, Roseby R, Wiggers JH. Interventions by health care professionals who provide routine child health care to reduce tobacco smoke exposure in children: a review and meta-analysis. JAMA Pediatr 2016; 170 (02) 138-147
    CrossrefPubMedGoogle Scholar
  • 10 Behbod B, Sharma M, Baxi R, Roseby R, Webster P. Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke. Cochrane Database Syst Rev 2018; 1 (01) CD001746
    PubMedGoogle Scholar
  • 11 Jenssen BP, Kelly MK, Faerber J. et al. Parent preferences for pediatric clinician messaging to promote smoking cessation treatment. Pediatrics 2020; 146 (01) e20193901
    CrossrefPubMedGoogle Scholar
  • 12 Jenssen BP, Kelly MK, Faerber J. et al. Pediatrician delivered smoking cessation messages for parents: a latent class approach to behavioral phenotyping. Acad Pediatr 2021; 21 (01) 129-138
    CrossrefPubMedGoogle Scholar
  • 13 Fiore MC, Jaén CR, Baker TB. et al. Treating tobacco use and dependence: 2008 update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service; 2008
    Google Scholar
  • 14 Farber HJ, Groner J, Walley S, Nelson K. Section on Tobacco Control. Protecting children from tobacco, nicotine, and tobacco smoke. Pediatrics 2015; 136 (05) e1439-e1467
    CrossrefPubMedGoogle Scholar
  • 15 Montori VM, Breslin M, Maleska M, Weymiller AJ. Creating a conversation: insights from the development of a decision aid. PLoS Med 2007; 4 (08) e233
    CrossrefPubMedGoogle Scholar
  • 16 Martinez W, Hackstadt AJ, Hickson GB. et al. The My Diabetes Care Patient Portal Intervention: usability and pre-post assessment. Appl Clin Inform 2021; 12 (03) 539-550
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Boyle R, Solberg L, Fiore M. Use of electronic health records to support smoking cessation. Cochrane Database Syst Rev 2014; 2014 (12) CD008743
    PubMedGoogle Scholar
  • 18 Vidrine JI, Shete S, Li Y. et al. The Ask-Advise-Connect approach for smokers in a safety net healthcare system: a group-randomized trial. Am J Prev Med 2013; 45 (06) 737-741
    CrossrefPubMedGoogle Scholar
  • 19 Hood-Medland EA, Stewart SL, Nguyen H. et al. Health system implementation of a tobacco quitline eReferral. Appl Clin Inform 2019; 10 (04) 735-742
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Fiore M, Adsit R, Zehner M. et al. An electronic health record-based interoperable eReferral system to enhance smoking Quitline treatment in primary care. J Am Med Inform Assoc 2019; 26 (8-9): 778-786
    CrossrefPubMedGoogle Scholar
  • 21 Drake LA, Suresh K, Chrastil H, Lewis CL, Altman RL. Improving tobacco cessation rates using inline clinical decision support. Appl Clin Inform 2022; 13 (05) 1116-1122
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Taylor GMJ, Dalili MN, Semwal M, Civljak M, Sheikh A, Car J. Internet-based interventions for smoking cessation. Cochrane Database Syst Rev 2017; 9 (09) CD007078
    PubMedGoogle Scholar
  • 23 Vilaplana J, Solsona F, Abella F, Cuadrado J, Alves R, Mateo J. S-PC: an e-treatment application for management of smoke-quitting patients. Comput Methods Programs Biomed 2014; 115 (01) 33-45
    CrossrefPubMedGoogle Scholar
  • 24 Nguyen Thanh V, Guignard R, Lancrenon S. et al. Effectiveness of a fully automated internet-based smoking cessation program: a randomized controlled trial (STAMP). Nicotine Tob Res 2019; 21 (02) 163-172
    CrossrefPubMedGoogle Scholar
  • 25 Pifarré M, Carrera A, Vilaplana J. et al. TControl: a mobile app to follow up tobacco-quitting patients. Comput Methods Programs Biomed 2017; 142: 81-89
    CrossrefPubMedGoogle Scholar
  • 26 Sharifi M, Adams WG, Winickoff JP, Guo J, Reid M, Boynton-Jarrett R. Enhancing the electronic health record to increase counseling and quit-line referral for parents who smoke. Acad Pediatr 2014; 14 (05) 478-484
    CrossrefPubMedGoogle Scholar
  • 27 Jenssen BP, Bryant-Stephens T, Leone FT, Grundmeier RW, Fiks AG. Clinical decision support tool for parental tobacco treatment in primary care. Pediatrics 2016; 137 (05) e20154185
    CrossrefPubMedGoogle Scholar
  • 28 Jenssen BP, Shelov ED, Bonafide CP, Bernstein SL, Fiks AG, Bryant-Stephens T. Clinical decision support tool for parental tobacco treatment in hospitalized children. Appl Clin Inform 2016; 7 (02) 399-411
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Jenssen BP, Muthu N, Kelly MK. et al. Parent eReferral to tobacco quitline: a pragmatic randomized trial in pediatric primary care. Am J Prev Med 2019; 57 (01) 32-40
    CrossrefPubMedGoogle Scholar
  • 30 Nabi-Burza E, Drehmer JE, Hipple Walters B. et al. Treating parents for tobacco use in the pediatric setting: the clinical effort against secondhand smoke exposure cluster randomized clinical trial. JAMA Pediatr 2019; 173 (10) 931-939
    CrossrefPubMedGoogle Scholar
  • 31 Scheffers-van Schayck T, Hipple Walters B, Otten R, Kleinjan M. Implementation of a proactive referral tool for child healthcare professionals to encourage and facilitate parental smoking cessation in the Netherlands: a mixed-methods study. BMC Health Serv Res 2021; 21 (01) 973
    CrossrefPubMedGoogle Scholar
  • 32 Blythe MJ, Del Beccaro MA. Committee on Adolescence, Council on Clinical and Information Technology. Standards for health information technology to ensure adolescent privacy. Pediatrics 2012; 130 (05) 987-990
    CrossrefPubMedGoogle Scholar
  • 33 Webber EC, Brick D, Scibilia JP, Dehnel P. Council on Clinical Information Technology, Committee on Medical Liability and Risk Management, Section on Telehealth Care. Electronic communication of the health record and information with pediatric patients and their guardians. Pediatrics 2019; 144 (01) e20191359
    CrossrefPubMedGoogle Scholar
  • 34 Jenssen BP, Thayer J, Nekrasova E, Grundmeier RW, Fiks AG. Innovation in the pediatric electronic health record to realize a more effective platform. Curr Probl Pediatr Adolesc Health Care 2022; 52 (01) 101109
    CrossrefPubMedGoogle Scholar
  • 35 Karsh B-T. Clinical practice improvement and redesign: how change in workflow can be supported by clinical decision support. AHRQ Publication No. 09-0054-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2009
    Google Scholar
  • 36 Gulliksen J, Göransson B, Boivie I, Blomkvist S, Persson J, Cajander Å. Key principles for user-centred systems design. Behav Inf Technol 2003; 22 (06) 397-409
    CrossrefPubMedGoogle Scholar
  • 37 Belden JL, Wegier P, Patel J. et al. Designing a medication timeline for patients and physicians. J Am Med Inform Assoc 2019; 26 (02) 95-105
    CrossrefPubMedGoogle Scholar
  • 38 Curran RL, Kukhareva PV, Taft T. et al. Integrated displays to improve chronic disease management in ambulatory care: a SMART on FHIR application informed by mixed-methods user testing. J Am Med Inform Assoc 2020; 27 (08) 1225-1234
    CrossrefPubMedGoogle Scholar
  • 39 ISO 9241-210:2019. In: Ergonomics of human-system interaction-Part 210: human-centred design for interactive systems. 2nd ed. 2019 https://www.iso.org/cms/render/live/en/sites/isoorg/contents/data/standard/07/75/77520.html
    PubMed
  • 40 Nielsen J. Usability Engineering. New York: Academic Press; 1993
    CrossrefGoogle Scholar
  • 41 Kushniruk AW, Patel VL. Cognitive and usability engineering methods for the evaluation of clinical information systems. J Biomed Inform 2004; 37 (01) 56-76
    CrossrefPubMedGoogle Scholar
  • 42 Jenssen BP, Karavite DJ, Kelleher S. et al. Electronic health record-embedded, behavioral science-informed system for smoking cessation for the parents of pediatric patients. Appl Clin Inform 2022; 13 (02) 504-515
    Article in Thieme ConnectPubMedGoogle Scholar
  • 43 Fiks AG, Grundmeier RW, Margolis B. et al. Comparative effectiveness research using the electronic medical record: an emerging area of investigation in pediatric primary care. J Pediatr 2012; 160 (05) 719-724
    CrossrefPubMedGoogle Scholar
  • 44 Philadelphia Department of Public Health. Tobacco use in Philadelphia. Chart 2021; 6 (08) 1-7
    PubMedGoogle Scholar
  • 45 Matkin W, Ordóñez-Mena JM, Hartmann-Boyce J. Telephone counselling for smoking cessation. Cochrane Database Syst Rev 2019; 5 (05) CD002850
    CrossrefPubMedGoogle Scholar
  • 46 Whittaker R, McRobbie H, Bullen C, Rodgers A, Gu Y, Dobson R. Mobile phone text messaging and app-based interventions for smoking cessation. Cochrane Database Syst Rev 2019; 10 (10) CD006611
    Google Scholar
  • 47 Pérez-Stable EJ, Juarez-Reyes M, Kaplan C, Fuentes-Afflick E, Gildengorin V, Millstein S. Counseling smoking parents of young children: comparison of pediatricians and family physicians. Arch Pediatr Adolesc Med 2001; 155 (01) 25-31
    CrossrefPubMedGoogle Scholar
  • 48 U.S. Department of Health and Human Services. Smoking cessation: a report of the Surgeon General. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Washington (DC): U.S. Department of Health and Human Services; 2020
    Google Scholar
  • 49 Babb S, Malarcher A, Schauer G, Asman K, Jamal A. Quitting smoking among adults - United States, 2000-2015. MMWR Morb Mortal Wkly Rep 2017; 65 (52) 1457-1464
    CrossrefPubMedGoogle Scholar
  • 50 Jamal A, Dube SR, Malarcher AM, Shaw L, Engstrom MC. Centers for Disease Control and Prevention (CDC). Tobacco use screening and counseling during physician office visits among adults–National Ambulatory Medical Care Survey and National Health Interview Survey, United States, 2005-2009. MMWR Suppl 2012; 61 (02) 38-45
    PubMedGoogle Scholar