Patient navigation among recently hospitalized smokers to promote tobacco treatment: Results from a randomized exploratory pilot study

Highlights

• Behavioral interventions with post-discharge contacts promote smoking cessation.

• Unclear how to optimize interventions for patients with health-related social needs.

• Study utilized patient navigation with screening for social needs.

• This approach should integrate with hospital tobacco treatment services.

Abstract

Introduction

Adding screening for health-related social needs to tobacco treatment interventions initiated during hospitalizations may improve intervention effectiveness among vulnerable populations. Our objective was to examine the effect the acceptability and feasibility of a intervention in which a patient navigator screens for and addresses social needs to increase receipt of smoking cessation medication among recently hospitalized smokers at a safety-net hospital.

Methods

In a two-group randomized exploratory pilot study, we assigned hospitalized smokers to either the Enhanced Traditional Control (ETC) group (list of smoking cessation resources) or ETC + Patient Navigation (up to 10 h of navigation over a 3-month period, in which a navigator screens for and addresses health-related social needs). We assessed socio-demographics, smoking-related variables, and process data.

Results

Of 171 individuals screened, 44 (26%) were enrolled. Participants (mean age = 54.9 years, 61.4% non-Hispanic black, 68.2% high school education or less) smoked a mean of 11.4 cigarettes/day. 20 participants received a prescription for a cessation medication, 42.9% in the ETC group and 47.8% in the ETC + Patient Navigation group. 11 participants (47.8%) in the ETC + Patient Navigation group received the minimum intervention dose (completion of the social needs screener and at least one counseling session). Barriers to navigation were participants’ medical illness and difficulty connecting with participants.

Conclusions

Although nearly half of hospitalized smokers receiving support from a patient navigator received a prescription for a smoking cessation medication, the percentage did not differ by study arm. Refinement of the protocol to coordinate with hospital-wide tobacco treatment and social needs screening initiatives is needed.

Introduction

Providing tobacco treatment interventions to smokers during hospital stays may be an effective window of opportunity to promote cessation. A 2012 systematic review found that high-intensity behavioral interventions including at least one month of post-discharge contacts promoted cessation (Rigotti, Clair, Munafò, & Stead, 2012) and other trials since that time have supported these findings (Ellerbeck et al., 2019, Herbst et al., 2020, Rigotti et al., 2017). In safety-net hospital settings where there are many patients from vulnerable groups (e.g., racial/ethnic minorities, individuals with low income, or those with psychological symptoms), hospitalized patients have high smoking prevalence and unmet social needs (e.g., food insecurity, homelessness) (Buitron de la Vega et al., 2019), which are related to continued smoking (Baggett and Rigotti, 2010, Kim-Mozeleski and Pandey, 2020). One trial in a safety-net hospital in New York City found that post-discharge telephone counseling by masters-level counselors with mental health training promoted self-reported six-month cessation compared to a quit line referral (Sherman et al., 2016). To advance tobacco treatment interventions among hospitalized smokers in safety-net settings, tailoring programs to address patients’ unmet social needs may increase these programs’ efficacy and potential sustainability. Patient navigators, who are lay persons from the communities served by the safety-net system, may be in an optimal position to promote cessation medications and to address social needs (Lasser et al., 2013, Lasser et al., 2017). We are unaware of prior studies that have added screening for social needs to hospital-based tobacco treatment; our study advances tobacco treatment literature by examining such an intervention approach in a safety net hospital setting. The objective of this exploratory pilot study is to determine the acceptability and feasibility of a patient navigation tobacco treatment intervention that includes screening and referral for social needs to increase prescription of post-discharge cessation medications among hospitalized smokers.