A Mobile App to Enhance Smoking Cessation Shared Decision Making in Primary Care

Smoking is the leading preventable cause of death in the United States. Primary care physicians (PCPs) can help patients quit smoking, but they lack tools to quickly and effectively engage patients and share evidence-based treatments. With so many options for cessation support, it is important for clinicians to apply patient-centered outcomes research (PCOR) and personalize evidence-based interventions that are both useful and appealing to patients.

This project developed and tested a tablet-based mobile health (mHealth) application (app) called e-Quit worRx™ to assist PCPs in disseminating PCOR smoking cessation evidence and to support shared decision making with patients. The app collects a comprehensive smoking history, stage of change, and dependence level from the patient before presenting them with customized personalized feedback and evidence-based strategies to quit. The app was also designed to minimize clinical time burden.

The specific aims of the project were as follows:

• Develop an acceptable and usable smoking cessation decision aid that incorporates PCOR evidence into an mHealth tablet-based app. 
• Pilot test the final e-Quit worRx app compared to a generic pamphlet in primary care offices, with a goal of enhancing patient-centered shared decision making about smoking cessation. 

Researchers iteratively developed and pilot-tested the e-Quit worRx app within an academic health center and an associated primary care network. The project team then conducted a randomized controlled trial with 36 control patients and 37 intervention patients. Intervention patients used the e-Quit worRx app while waiting in the exam room for their PCP, while the control group was asked to review a smoking cessation booklet during their wait. The trial consisted of a single study visit during an appointment with the patient’s PCP, and a 12-week followup phone call.

Findings indicated that the app significantly increased the time patients spent discussing smoking cessation with their PCPs and increased the likelihood that a decision about their smoking was made at the time of the visit, even if the decision was to make no changes. At the time of the followup calls, 22 percent of control patients versus 46 percent of intervention patients reported that they were seriously thinking of quitting smoking within the next 30 days. Researchers hypothesized that if this technology can be further integrated into electronic health record systems, acceptability among provider will increase and the app may further improve patient-centered care, shared decision-making, and patient engagement.