A personalized biomedical risk assessment infographic may lead to more frequent physician-delivered smoking cessation counseling among patients with chronic obstructive pulmonary disease who smoke. However, the intervention reached just 50% of the eligible patients.

In a feasibility study, researchers assigned patients to receive usual care during the first year (preintervention; n = 87) and personalized biomedical risk assessment infographics generated from spirometry data during the second year (intervention; n = 104). The infographic illustrated projected lung function decline with continued smoking vs. smoking cessation, provided expected clinical consequences, and included guidance on smoking cessation pharmacotherapy. The researchers enrolled current smokers with chronic obstructive pulmonary disease (COPD) referred for spirometry by participating pulmonologists, primary care physicians, and nurse practitioners. They assessed physician delivery of smoking cessation counseling, prescription or recommendation of smoking cessation pharmacotherapy, referrals to smoking cessation programs, recommendations for nonpharmacologic smoking cessation strategies, changes in respiratory medications, intervention uptake, and physician feedback.

Smoking cessation counseling was provided during 81% vs. 67% of the eligible visits in the intervention and postintervention periods, respectively, representing approximately twice the odds of counseling following implementation of the infographic. Recommendations or prescriptions for smoking cessation pharmacotherapy increased from 12% to 18% of the eligible visits, although the study did not detect a statistically significant difference between the periods.

Physicians prescribed new respiratory medications more frequently during the intervention period, while discontinuation of respiratory medications occurred less often. Referrals to smoking cessation programs and recommendations for other nonpharmacologic smoking cessation strategies were similar between the study periods.

The infographic was successfully generated and delivered during only 50% of the eligible visits, reflecting limited implementation fidelity. However, all of the responding physicians reported that the infographic contained intuitive and useful information, with most suggesting it improved the efficiency of smoking cessation discussions and that they would continue receiving the infographic after the study.

The researchers cautioned that the findings should be interpreted within the context of the study design. The intervention was conducted at a single center using a preintervention-postintervention design without a concurrent control group, making the observed behavioral changes susceptible to temporal confounding. The sample size was smaller than anticipated because spirometry volumes declined during the COVID-19 pandemic, and workflow challenges in the pulmonary function laboratory limited intervention delivery. The researchers said improving automation of infographic generation and delivery should precede evaluation in a larger randomized controlled trial.

"[O]ur study suggests that a personalized biomedical risk assessment infographic increases smoking cessation counselling rates and may alter COPD management," wrote lead study author Mark William Youssef, of the Department of Medicine at the University of Toronto, and colleagues.

The study authors reported no competing interests.

Source: BMC Pulmonary Medicine