Aims
The Care to Quit (C2Q) trial examined the effects of an implementation intervention to support abstinence from smoking and the provision of smoking cessation care.
Methods
C2Q was a stepped wedge cluster randomised trial involving nine Australian cancer centres in NSW (n=7) and Victoria (n=2). Intervention delivery was staggered by six months between each cluster of three sites. People at the participating sites were exposed to the intervention either as staff who received the implementation intervention directly, or as patients attending for care via staff. Eligible consenting people receiving anti-cancer therapy completed baseline assessment at enrolment and seven months later. Staff measures (surveys and record audits) were collected during pre- and post-intervention periods.
Results
People with cancer (n=315 of an intended n=1860) and staff (n=308 of an intended 270) were recruited to the study. In the intention to treat analysis the intervention was not associated with a change in the odds of 6-month prolonged abstinence from smoking, compared with control periods (OR 1.04, 95% CI 0.33–3.30; p = 0.95). In the as-treated analysis using imputed data, odds of 6-month prolonged abstinence had a wide confidence interval which included the null (OR 0.61, 95% CI 0.23–1.63; p = 0.33). Bayesian analysis indicated uncertainty in the anticipated treatment effect if additional participants were recruited. A higher proportion of participants recruited after intervention commencement reported being offered help to quit or stay smoke-free (p = 0.043) compared to baseline period. There were significant pre-post differences in staff-reported referral to Quitline (p = 0.003), advice to use Nicotine Replacement Therapy (p = 0.008), and prescribing or referring for NRT (p = 0.019).
Conclusion
While the study was underpowered to find a difference in smoking abstinence, the implementation intervention had a positive effect on the reported provision of smoking cessation care.