A personalized biomedical risk assessment infographic for people who smoke with COPD: a qualitative study

Samir Gupta,Mohsen Sadatsafavi,Puru Panchal,Parisa Ghanouni,Zafar Zafari,Smita Pakhale,Laura Nimmon,Teresa To,Don Sin,For The Canadian Respiratory Research Network

doi:10.1186/s13722-021-00283-1

Abstract

BackgroundChronic obstructive pulmonary disease (COPD) causes 3 million deaths each year, yet 38% of COPD patients continue to smoke. Despite proof of effectiveness and universal guideline recommendations, smoking cessation interventions are underused in practice. We sought to develop an infographic featuring personalized biomedical risk assessment through future lung function decline prediction (with vs without ongoing smoking) to both prompt and enhance clinician delivery of smoking cessation advice and pharmacotherapy, and augment patient motivation to quit.MethodsWe recruited patients with COPD and pulmonologists from a quaternary care center in Toronto, Canada. Infographic prototype content and design was based on best evidence. After face validation, the prototype was optimized through rapid-cycle design. Each cycle consisted of: (1) infographic testing in a moderated focus group and a clinician interview (recorded/transcribed) (with questionnaire completion); (2) review of transcripts for emergent/critical findings; and (3) infographic modifications to address findings (until no new critical findings emerged). We performed iterative transcript analysis after each cycle and a summative qualitative transcript analysis with quantitative (descriptive) questionnaire analysis.ResultsStopping criteria were met after 4 cycles, involving 20 patients (58% male) and 4 pulmonologists (50% male). The following qualitative themes emerged: Tool content (infographic content preferences); Tool Design (infographic design preferences); Advantages of Infographic Messaging (benefits of an infographic over other approaches); Impact of Tool on Determinants of Smoking Cessation Advice Delivery (impact on barriers and enablers to delivery of smoking cessation advice in practice); and Barriers and Enablers to Quitting (impact on barriers and enablers to quitting). Patient Likert scale ratings of infographic content and format/usability were highly positive, with improvements in scores for 20/21 questions through the design process. Providers scored the infographic at 77.8% (“superior”) on the Suitability Assessment of Materials questionnaire.ConclusionsWe developed a user preference-based personalized biomedical risk assessment infographic to drive smoking cessation in patients with COPD. Our findings suggest that this tool could impact behavioural determinants of provider smoking-cessation advice delivery, while increasing patient quit motivation. Impacts of the tool on provider care, patient motivation to quit, and smoking cessation success should now be evaluated in real-world settings.

Highlights

Chronic obstructive pulmonary disease (COPD) causes 3 million deaths each year, yet 38% of COPD patients continue to smoke
We identified which patient-relevant outcomes could be differentiated between Global initiative for chronic obstructive lung disease (GOLD) stages, including the following candidate outcomes for display in the infographic: mortality, frequency of COPD exacerbations, healthcare utilization, dyspnea, exercise tolerance, quality of life, mental health, and fatigue [26,27,28,29,30,31,32,33]
The four pulmonologists recruited for interviews had been in practice for 1–20 years and reported seeing between 2 and 20 COPD patients per week

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) causes 3 million deaths each year, yet 38% of COPD patients continue to smoke. Given that smoking status is the only modifiable risk factor affecting an individual’s future rate of FEV1 decline [11], this created an opportunity to calculate and report the differing personalized impact of ongoing smoking versus smoking cessation on future FEV1 in people with COPD who smoke. Such assessments—called personalized biomedical risk assessments—have previously been shown to effectively improve health behaviours. Personalized estimates of future melanoma risk have been shown to increase use of sun protection [12], a personal skin photography intervention improved skin examination behaviour [13], and individualized genetic risk estimates enabled improvements in diet [14]

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