Telephone Counseling Research Articles

The effect of telephone counseling and internet-based support on pain and recovery after tonsil surgery in children - a systematic review.

The recovery after tonsil surgery is often troublesome for children and caregivers often feel insecure regarding optimal post-operative care for their children at home.The aim was to study what the current literature reports regarding the effect of post-operative telephone counselling and Internet support on pain and recovery after paediatric tonsil surgery. A systematic literature review was conducted where only randomised clinical trials were included. Primary outcome measure was pain after surgery. Secondary outcomes also included nausea, anxiety, children's knowledge, use of analgesics, fluid intake and health care service use. Only four studies fulfilled the inclusion criteria. The studies were heterogeneous, rendering a meta-analysis impossible. The results of the included studies showed a possible positive effect on postoperative pain, as well as level of anxiety, use of analgesics, fluid intake and health care service use. However, the studies were few with few included participants. There were indications, but no definitive evidence supporting the positive effect of telephone counselling or Internet-based support on pain and recovery after tonsil surgery in children. More research is needed to further examine these effects.ClinicalTrials.gov 12/03/2017 (NCT03292068).

Finnish e-health services intended for citizens – national and regional development

Electronic health care (e-health) services intended for Finnish citizens have been recently developed nationally, regionally, and locally through several projects and programs. This study aimed to investigate the development and availability of e-health services for Finnish citizens in specialized and primary health care and private medical service providers from 2011 to 2020. In addition, the differences between the availability of services in different sectors and regional differences between hospital districts were investigated. Data were collected using web-based questionnaires in 2011, 2014, 2017, and 2020 from “Use of information and communication technology surveys in Finnish health care”. This study covers all 21 hospital districts, nearly all primary health care centers, and a sample of private medical service providers. Quantitative data were analyzed using SPSS software (version 25). The availability of an e-health service was calculated as a percentage of all respondents in each sector. The results of this study show that public and private health care organizations extensively offered health care services on their websites. Almost all organizations had information on well-being, provided services, contact methods, and locations, as well as options to send electronic feedback. Remote consultation, electronic appointment booking services, and telephone counseling were also extensively offered. This study revealed that the volume of e-health services increased from 2011 to 2020. For instance, remote consultation services and information exchange through encrypted email increased rapidly during follow-up periods in all service sectors. Comparing service sectors revealed that specialized health care covers e-health services more extensively than do primary health care and private service providers. According to this study, there are also clear differences in the availability of services between hospital districts and no hospital district offered all studied services. These results suggest the need to clarify national and regional development responsibilities and standardize the availability of e-health services within and between hospital districts.

Understanding engagement behaviors and rapport building in tobacco cessation telephone counseling: An analysis of audio-recorded counseling calls

IntroductionThough telephone counseling is a modality commonly used to promote health behavior change, including tobacco cessation, specific counselor and participant behaviors that indicate engagement and therapeutic alliance remain poorly characterized in the literature. We sought to explore smokers' and counselors' engagement and rapport-building behaviors in telephone counseling for smoking cessation and patterns of these behaviors by smokers' psychiatric symptoms. MethodsThe study team transcribed, audio-recorded tobacco cessation counseling calls for the presence of engagement and rapport-building behaviors among recently hospitalized participants enrolled in a smoking cessation randomized controlled trial (RCT). The study used baseline data from the RCT to explore frequencies of counselors' and smokers' behaviors among smokers who had reported more (vs. fewer) symptoms of depression (PHQ8 ≥ 10) or anxiety (GAD7 ≥ 10) at study entry. ResultsParticipants (n = 37) were mostly female (23/37), White (26/37), with a median age of 58. At study entry while hospitalized, moderate-to-severe symptoms of depression (18/37) and anxiety (22/37) were common. Participant-led engagement behaviors included referencing past quit attempts, asking questions, elaborating response to yes/no questions, expressing commitment to behavior change, and assigning importance to nonautomated calls. Counselor-led behaviors included building off prior interaction, empathy, normalizing challenges, reframing and summarizing, validating achievements, and expressing shared experience. Both participants and counselors engaged via general discussion and humor. Participant-led engagement behaviors appeared more often in call transcripts among patients with higher baseline depression and anxiety symptoms compared to those with lower symptom scores. ConclusionsThis study classified participant-led, counselor-led, and shared engagement behaviors during tobacco cessation counseling calls. Increased engagement via telephone counseling may be important for individuals with psychiatric symptoms identified at the start of treatment.

Population wellbeing and psychosocial burden during the COVID-19 Pandemic in Germany – results from (bi-)weekly monitoring data and the resulting health promoting activities on the national level

Abstract Since march 2020, data on risk perception, behavior and psychosocial wellbeing of the population with regard to the COVID-19 pandemic have been collected regularly (biweekly to weekly) in Germany as part of the COVID-19 Snapshot Monitoring (COSMO). The data i.e. show that the psychosocial burden is higher in specific population subgroups, such as younger adults and families. Based on these data, the Federal Centre for Health Education as part of the federal government developed health promoting activities on the national level to maintain wellbeing and buffer the burden. Over the course of the pandemic, these activities changed dynamically according to the differing situation (lock-down, incidence). With the second wave, as incidences increased dramatically without vaccination available, the activities were expanded from a web-based platform ‘Psychisch stabil bleiben' (Mind your mental health), supported by a nationwide telephone counseling service, to a nationwide mail distribution of postcards in five different languages, with links to the virtual platform and various telephone counselling services. The website offers information on coping strategies and psychotherapeutic services, edited for specific population groups (e.g. parents, people with preexisting mental illness, health professionals) in five different languages. The postcards were distributed through primary care providers, pharmacies and social services in socially disadvantaged geographical areas, trying to increase reach in vulnerable populations.

Effect of continuous supportive telephone counselling on improving breastfeeding self-efficacy in mothers with late preterm infants four months after discharge: A randomized, controlled study.

BackgroundBreastfeeding self-efficacy is an important motivational factor in the continuity of lactation in mothers with preterm infants.ObjectiveThe study aimed to determine the effect of continuous supportive telephone counselling on improving breastfeeding self-efficacy in mothers with late preterm infants.Material and methodsThis randomized, controlled study was carried out with 65 eligible mothers (control n = 32, intervention n = 33) recruited in Ahvaz, Iran, in 2020. The eligible women were allocated into two groups— intervention and control—according to the block design. Data were measured monthly up to four months after discharge using the Dennis Breastfeeding Self-Efficacy Questionnaire. The control group received only routine care. Continuous supportive telephone counselling was provided for the intervention group members daily for 14 days after neonatal discharge. Data were analyzed using chi-square, repeated measures analysis of variance, independent t-test, and paired t-test at the significant level of 0.05. Statistical analysis was performed using the SPSS 16.0 software (SPSS Inc., Chicago, IL, USA).ResultsThe overall score in breastfeeding self-efficacy showed a statistically significant difference between the two study groups during the four months after discharge compared to the pre-intervention stage (P = 0.001). In the intervention group, the mean score of breastfeeding self-efficacy increased from 33.18 to 53.48, and in the control group it decreased from 31.17 to 28.56.ConclusionThe results showed that continuous supportive telephone counselling can improve breastfeeding self-efficacy in mothers with preterm infants. The approach seems to be an acceptable basis for designing intervention programs in this field.

Effects of Dietary App-Supported Tele-Counseling on Sodium Intake, Diet Quality, and Blood Pressure in Patients With Diabetes and Kidney Disease

The aim of this study is to examine the effect of a telehealth intervention that used a dietary app, educational website, and weekly dietitian tele-counseling on sodium intake, diet quality, blood pressure, and albuminuria among individuals with diabetes and early-stage chronic kidney disease. We examined the effects of a dietary app-supported tele-counseling intervention in a single center, single arm study of 44 participants with type 2 diabetes and stage 1-3a chronic kidney disease. Participants recorded and shared dietary data via MyFitnessPal with registered dietitians, who used motivational interviewing to provide telephone counseling weekly for 8weeks. After the 8-week intensive intervention, participants were followed at 6 and 12months. Outcomes included 24-hour urine sodium (2 collections per timepoint), Healthy Eating Index 2015 score (three 24-hour dietary recalls per timepoint), 24-hour systolic blood pressure (SBP) and diastolic blood pressure (DBP), and 24-hour urine albumin excretion. Out of 44 consented participants (mean age 60.3 ± 11.9years, 43% female, 89% white, median estimated glomerular filtration rate was 78.5mL/min/1.73m2, median urine albumin excretion 52.9mg/day, 84% hypertension), 32 (73%) completed 8-week follow-up, 27 (61%) completed 6-month follow-up, and 25 (57%) completed 12-month follow-up. Among participants who completed 12-month follow-up, reported sodium intake decreased by 638mg/day from baseline of 2,919mg/day (P < .001). The 24-hour mean urine sodium and albumin excretion did not decline over the study period. Healthy Eating Index 2015 score improved by 7.76 points at 12months from a mean baseline of 54.6 (P < .001). Both 24-hour SBP and DBP declined at 12months from baseline (SBP -5.7 mm Hg, 95% confidence interval -10.5 to -1.0, P=.02; DBP -4.1 mm Hg, 95% confidence interval -7.2 to -1.1, P=.01). Overall, this study demonstrates that a short, intensive, remotely delivered dietary intervention for adults with type 2 diabetes and early chronic kidney disease at high risk for disease progression and cardiovascular complications led to improvement in blood pressure and self-reported sodium intake and diet quality, but no improvement in albuminuria. Future research studies are needed to examine whether remotely delivered dietary interventions can ultimately improve kidney health over time.

Practical Report of Disaster-Related Mental Health Interventions Following the Great East Japan Earthquake during the COVID-19 Pandemic: Potential for Suicide Prevention.

Background: This practical report aims to publicize the ongoing disaster-related mental health interventions following the Great East Japan Earthquake during the COVID-19 pandemic. Methods: Disaster-related mental health interventions consisted of: (1) screening high-risk evacuees with high psychological distress (Kessler 6 score ≥ 13) or binge drinking; and (2) visiting selected high-risk individuals and providing them counseling through outreach in evacuee housing. These activity records were compiled from existing material in the Sendai City Office; therefore, no new interviews or questionnaire surveys were conducted. Results: During the COVID-19 pandemic, we introduced telephone counseling and shortened the time of support as a result of the restrictions. Counselors addressed issues of “loneliness” or “isolation” among evacuees, who had little connection with society due to the pandemic. Moreover, the procedure for obtaining COVID-19 special financial aid was explained to evacuees in financial difficulty. During this period, the suicide rates in the affected area did not increase significantly as compared to the national average. Conclusions: Our report may be instructive in terms of preventing suicide during the pandemic using high-risk approaches and counselors trained in disaster-related mental health interventions.

The effect of progressive relaxation exercises on treatment-related symptoms and self-efficacy in patients with lung cancer receiving chemotherapy

BackgroundPatients with lung cancer receiving chemotherapy experience many symptoms, simultaneously or separately, that limit their daily living activities. This study aimed to determine the effect of progressive relaxation exercises on treatment-related symptoms and self-efficacy in patients with lung cancer receiving chemotherapy. Materials and methodsThis randomized controlled experimental study was conducted in a university hospital chemotherapy outpatient clinic in Turkey. The study sample consisted of 84 patients, randomly allocated to an experimental group (n = 42) and a control group (n = 42). The experimental group received applied training in progressive relaxation exercises using an MP3 player. The control group received only standard nursing interventions in the chemotherapy unit. Data were collected from patients using a personal information form, a telephone counseling follow-up form, the Memorial Symptom Assessment Scale and the Strategies Used by People to Promote Health Scale. Data collection tools were administered at four different times (at first interview and three times on the seventh day of the end of the chemotherapy cycle) and weekly telephone follow-ups were performed. ResultsThe symptom scores (frequency, severity and level of distress) significantly decreased in the experimental group, compared with the control group (p = 0.0001). Similarly, self-efficacy scores significantly improved in the experimental group (p = 0.001). ConclusionProgressive relaxation exercises were potentially effective in promoting symptom management and improving the level of self-efficacy.

Acceptance of Psycho-Oncological Counseling Formats in a Cancer Counseling Center during the COVID-19 Pandemic: An Exploratory Care Study.

Background: The COVID-19 pandemic made it necessary to change established structures of medical counseling services and quickly establish digital counseling formats to ensure continuity of care. In this context, we offered telephone and video-telephonic counseling in addition to traditional face-to-face counseling in the office. Methods: Patients (n = 100) of the Cancer Counseling Center, Tübingen, were asked to complete a questionnaire to assess the acceptance of the counseling format following each counseling session (office, telephone, and video) in the period between July 2020 and February 2021. The questionnaire included the subject areas of patient characterization, assessment of therapeutic contact, therapeutic relationship, and hurdles and was used in this exploratory care study. Results: The satisfaction and acceptance of the three counseling formats (office, telephone, and video) were rated as “good” to “very good” in the three subgroups (range 1–6, office M = 1.2, telephone M = 1.3, video M = 1.4). Likewise, the “therapeutic relationship” achieved high ratings in terms of establishment of a therapeutic relationship in all three subgroups (office M = 5.7, telephone M = 5.0, video M = 5.0). The type of contact (office and video counseling) achieved a significant main effect on the therapeutic relationship for items such as “I believe that counseling is helping me” (F(2,97) = 4.80, p = 0.01) and “I feel that I can rely on the counselor/therapist” (F(2,97) = 3.29, p = 0.04). The “hurdles” were rated as minor and tolerable (office M = 1.3, telephone M = 1.3, video M = 1.4). Predictor analyses showed that there was no effect of age and gender on the acceptance of digital counseling formats in the present sample. Discussion and Conclusion: On the basis of this survey, it can be concluded that digital counseling formats were perceived by patients as a promising addition to the classic face-to-face setting. In addition, it can be stated that the digital formats (telephone and video) were not generally preferred to face-to-face counseling, but that the innovative telecounseling was accepted and perceived with great satisfaction and acceptance. Accordingly, the additional use of digital counseling formats could be an opportunity to enrich and expand the existing presence structures also after the COVID-19 pandemic.

Effects of a partnership-based, needs-tailored self-management support intervention for post-treatment breast cancer survivors: A randomized controlled trial.

To examine the effectiveness of partnErship-based, needs-tailored self-Management support Program fOr Women with breast cancER (EMPOWER), a partnership-based, needs-tailored, self-management (SM) support intervention designed to empower post-treatment breast cancer survivors (BCSs) and ultimately improve their health outcomes. This multi-center, two-armed, randomized controlled trial comprised 94 female BCSs who had completed primary cancer treatment in South Korea. Participants were randomly assigned (1:1) to the intervention group or the wait-list control group. The intervention group received a 7-week EMPOWER intervention via telephone counseling. The primary outcome was empowerment. Secondary outcomes included self-efficacy for post-treatment SM behaviors, mental adjustment, anxiety, depression, and health-related quality of life. Data were collected via a self-reported questionnaire at baseline (T0) and at 8 (T1) and 20weeks (T2) of follow-up. Linear mixed models were used to assess group differences over time. Effective sizes were calculated using Cohen's d. Retention rates were excellent (95.7% at T1; 94.7% at T2). Linear mixed model analyses revealed that the EMPOWER group showed significantly improved empowerment (mean difference 2.24, 95% CI=0.18 to 4.29; p=0.016) and general health perception (mean difference 3.68, 95% CI=0.67 to 6.72; p=0.037) compared with the control group. Time point analysis showed that several secondary outcomes significantly improved at T1, but the effects were not sustained. EMPOWER was effective in improving empowerment and general health perception among post-treatment BCS. Further studies are needed to determine the effectiveness of the EMPOWER intervention in other cancer populations.

Relationship between Willingness and Psychological Characteristics of Suicide Prevention Telephone Counselors: A Retrospective Observational Study

Suicide is a major public health issue worldwide, and telephone counseling is an important preventive measure. As the number of telephone counselors is insufficient in Japan, public needs cannot be fully met. Willingness is important for securing telephone counselors, but few studies have examined the willingness to engage in telephone counseling activities. Therefore, we investigated the relationship between telephone counselors’ willingness to perform their activities and their psychological characteristics, health status, and received social support. In this study, a questionnaire survey was conducted by mail among telephone counselors belonging to the Federation of Inochi No Denwa in Japan. The total number of valid responses was 709 (recovery rate: 50.4%). Following an exploratory factor analysis, three factors were extracted: (1) willingness to engage in telephone counseling activities, (2) sense of being burdened by telephone counseling activities, and (3) sense of difficulty in coping. Structural equation modeling, using all the factors, showed that social support and grit were directly related to the willingness to engage in telephone counseling activities, while physical health, mental health, and general self-efficacy were indirectly related to it. The findings obtained may be useful in devising concrete measures for telephone counselors to continue their activities.

The effect of model-based telephone counseling on HbA1c and self-management for individuals with type 2 diabetes: A randomized controlled trial

AimsThis study was conducted to examine the effect of telephone counseling based on the Information, Motivation, Behavioral Skills (IMB) Model on HbA1c and self-management in patients with type 2 diabetes mellitus (T2DM). MethodsThis study was conducted between January 2019 and September 2019 with a total of 63 (31 interventions, 32 controls) T2DM patients. The intervention group was followed-up for a total of 12 weeks, after 45−60 min of patient training based on IMB, a weekly reminder message and a phone call every two weeks. No intervention was made to the control group. Data were collected at the beginning of the study and at the end of the 12th week. The data were obtained using a Patient Information Form, the Type 2 Diabetes Self-Efficacy Scale, the Diabetes Self-Management Questionnaire (DSMQ), the Perceived Diabetes Self Management Scale (PDSMS) and glycemic control (HbA1c). ResultsParticipants were on average 54 years old and the majority were female (58.1%). According to the results of the covariance analysis (ANCOVA), there was a statistically significant difference between the pre-post-test HbA1c (F:13.589; p < 0.001), weight (F:32.176; p < 0.001) and systolic blood pressure (F:7.109; p = 0.01). However, there was no significant difference in diastolic blood pressure between the intervention and control groups (F:2.686; p = 0.106). Also, after three months of follow-up, self-efficacy (F:26.632; p < 0.001), self-management (F:44.487; p < 0.001) and self-management perceptions (F:71.132; p < 0.001) were significantly higher in the intervention group. ConclusionThe researchers concluded that telephone counseling based on the IMB model could be a suitable method to improve glycemic control and self-care behaviors in patients with type 2 diabetes.

Randomized Community Trial Comparing Telephone versus Clinic-Based Behavioral Health Counseling for People Living with HIV in a Rural Setting.

To test the efficacy of a theory-based behavioral intervention delivered via telephone versus clinic-based counseling to improve HIV outcomes and reduce alcohol consumption for people at-risk for treatment failure in a rural setting. Patients receiving HIV care (N = 240) were randomized using a computer-generated scheme to one of three conditions: (a) telephone behavioral health counseling, (b) clinic-based behavioral health counseling, or (c) attention control nutrition education. Behavioral counseling was delivered by either a community nurse or a paraprofessional patient navigator, with differences examined. Participants were followed for 12 months to assess medication adherence using unannounced pill counts and alcohol use measured by electronic daily text message assessments, and 18 months for HIV viral load and retention in care extracted from medical records. There was evidence for telephone and office-based counseling demonstrating greater medication adherence than the control condition but only in the short term. Clinic-based behavioral counseling significantly reduced alcohol use to a greater degree than telephone counseling and the control condition. There were no other differences between conditions. There were also no discernable differences between counseling delivered by the community nurse and the patient navigator. Telephone and clinic-based counseling demonstrated improved medication adherence in the short term, while clinic-based counseling demonstrated reductions in alcohol use. The modest outcomes suggest that intensive intervention strategies are needed for patients that clinicians identify as at-risk for treatment discontinuation and treatment failure.

Virtual Care in Patients with Cancer: A Systematic Review.

Virtual care in cancer care existed in a limited fashion globally before the COVID-19 pandemic, mostly driven by geographic constraints. The pandemic has required dramatic shifts in health care delivery, including cancer care. We conducted a systematic review of comparative studies evaluating virtual versus in-person care in patients with cancer. Embase, APA PsycInfo, Ovid MEDLINE, and the Cochrane Library were searched for literature from January 2015 to 6 August 2020. We adhered to PRISMA guidelines and used the modified GRADE approach to evaluate the data. We included 34 full-text publications of 10 randomized controlled trials, 13 non-randomized comparative studies, and 5 ongoing randomized controlled trials. Evidence was divided into studies that provide psychosocial or genetic counselling and those that provide or assess medical and supportive care. The limited data in this review support that in the general field of psychological counselling, virtual or remote counselling can be equivalent to in-person counselling. In the area of genetic counselling, telephone counselling was more convenient and noninferior to usual care for all outcomes (knowledge, decision conflict, cancer distress, perceived stress, genetic counseling satisfaction). There are few data for clinical outcomes and supportive care. Future research should assess the role of virtual care in these areas. Protocol registration: PROSPERO CRD42020202871.

Symptom Experiences and Needs of Older Persons Living with Hemodialysis in Relation to Integrating Home Telehealth into Holistic End of Life Care: Phase I

Abstract The integration of home telehealth into holistic end of life care with nurse oversight for older persons living with hemodialysis is still limited in Thailand. This study explains the symptom experiences and health care needs related to integrating a home telehealth model into end of life care for older persons living with hemodialysis (OPLH). The paper represents the first phase of a mixed methods exploratory sequential study with dominant quantitative components, carried out over a six-month period. Purposive sampling was used to collect data from 100 OPLH. The instruments included the VOICES (View of Informal Carers Evaluation of Service-ESRD/Thai – patients’ version) questionnaire, the 9-item Thai Health Status Assessment questionnaire, and a demographic data form. The quantitative data were analysed using the statistical package SPSS version 17. Most of the participants had comorbid conditions (98%). The most common of these were hypertension (41.02%) followed by diabetes mellitus (23.25%). 25% had shortness of breath, and some had pain (31%), swelling (31%), anorexia some of the time (30%), and nausea and vomiting (15%). Moreover, participants also had symptoms of anxiety (23%), and moderate stress (10%). 8% had to be readmitted to hospital at least twice per month. Most participants had never received home care. The needs of the participants in relation to their holistic end of life care at home were reported in terms of: 1) knowledge of symptoms management at home; 2) activity and role management; 3) emotional management; and 4) spiritual support. The telehealth provision was mentioned by participants as an important part of their care, requiring VDO visiting, telephone counselling, and web-based education/ monitoring. Keywords: ESRD, Older persons living with hemodialysis (OPLH), Home telehealth.

Conquering nightmares on the phone: one-session counseling using imagery rehearsal therapy

Abstract Background Since people with nightmares rarely seek help, low-threshold interventions and self-help methods are needed. Among different treatment approaches for nightmares, imagery rehearsal therapy (IRT) is the method of choice. Objective In the current study, the authors tested whether IRT is also effective when applied in a short version, within the scope of a single session of telephone counseling. Methods The nightmare frequency and nightmare distress of 28 participants was investigated before and 8 weeks after one session of telephone counseling. The 30-minute session included information on nightmare etiology as well as a short version of IRT. The session was followed by an 8‑week period of self-practice. Participants were either part of a student group or part of a group of patients from a sleep laboratory. Within-group and between-group differences were assessed. There was no control group. Results The intervention significantly reduced nightmare frequency and nightmare distress in the total sample and in both samples individually analyzed. Effect sizes were very high compared to those of waiting-list control groups of similar studies. Conclusion We were able to show that a one-session intervention can be enough to achieve significant relief from nightmares. As nightmares are underdiagnosed and undertreated, this approach might help to provide a low-threshold intervention for nightmare sufferers.

Shared decision-making approach to taper postoperative opioids in spine surgery patients with preoperative opioid use: a randomized controlled trial.

Persistent opioid use is common after surgery, and patients with preoperative opioid use represent a major challenge in this regard. The aim of this randomized controlled trial was to determine the effect of a personalized opioid tapering plan vs standard of care in patients with a preoperative opioid use undergoing spine surgery at Aarhus University Hospital, Denmark. Postoperative outcomes included opioid use, pain, contacts with the healthcare system, patient satisfaction, and withdrawal symptoms. Overall, 110 patients were randomized; 55 into the intervention and control groups each. Five patients (proportion = 0.09, 95% confidence interval [CI] [0.04-0.21]) in the intervention group compared with 13 patients (0.25, 95% CI [0.15-0.39]) in the control group were unable to taper opioids to their preoperative consumption 1 month after discharge (P = 0.03) (primary outcome). Likewise, more patients in the intervention group succeeded in tapering opioids to zero 3 months after discharge (37 patients; 0.71, 95% CI [0.57-0.82] vs 23 patients; 0.43, 95% CI [0.30-0.56], P = 0.003). Fewer patients in the intervention group had pain-related contacts to health care the first 2 weeks after discharge (21 patients; 0.40, 95% CI [0.28-0.54] vs 31 patients; 0.60, 95% CI [0.46-0.73], P = 0.04). There was no difference in satisfaction with pain treatment over the first 2 weeks or the incidence of withdrawal symptoms during the first month after discharge. Pain intensity was similar between both groups at all time points. These results suggest that a personalized tapering plan at discharge combined with telephone counselling 1 week after discharge assists patients in postoperative opioid tapering.

Pain and smoking study (PASS): A comparative effectiveness trial of smoking cessation counseling for veterans with chronic pain

IntroductionSmoking is associated with greater pain intensity and pain-related functional interference in people with chronic pain. Interventions that teach smokers with chronic pain how to apply adaptive coping strategies to promote both smoking cessation and pain self-management may be effective. MethodsThe Pain and Smoking Study (PASS) is a randomized clinical trial of a telephone-delivered, cognitive behavioral intervention among Veterans with chronic pain who smoke cigarettes. PASS participants are randomized to a standard telephone counseling intervention that includes five sessions focusing on motivational interviewing, craving and relapse management, rewards, and nicotine replacement therapy versus the same components with the addition of a cognitive behavioral intervention for pain management. Participants are assessed at baseline, 6, and 12 months. The primary outcome is smoking cessation. ResultsThe 371 participants are 88% male, a median age of 60 years old (range 24–82), and smoke a median of 15 cigarettes per day. Participants are mainly white (61%), unemployed (70%), 33% had a high school degree or less, and report their overall health as “Fair” (40%) to “Poor” (11%). Overall, pain was moderately high (mean pain intensity in past week = 5.2 (Standard Deviation (SD) = 1.6) and mean pain interference = 5.5 (SD = 2.2)). Pain-related anxiety was high (mean = 47.0 (SD = 22.2)) and self-efficacy was low (mean = 3.8 (SD = 1.6)). ConclusionsPASS utilizes an innovative smoking and pain intervention to promote smoking cessation among Veterans with chronic pain. Baseline characteristics reflect a socioeconomically vulnerable population with a high burden of mental health comorbidities.

The association between heated tobacco product use and cigarette cessation outcomes among youth smokers: A prospective cohort study

IntroductionThe U.S. Food and Drug Administration authorized the marketing of heated tobacco products (HTPs) with modified-risk information for adults on July 7, 2020. However, the effects of HTP use on cigarette cessation among youth smokers remain unclear. This study aimed to explore the association of HTP use with cigarette abstinence and cessation outcomes among youth smokers in Hong Kong who were willing to receive telephone counseling for smoking cessation. MethodsThis prospective cohort study included youth smokers aged ≤25 years who were enrolled in the Hong Kong Youth Quitline service. From December 1, 2016, to September 30, 2019, this study identified as HTP users 106 youth cigarette smokers who reported using HTPs on at least 1 of the past 30 days at enrollment, and identified as non-HTP users 473 smokers who reported smoking at least one conventional cigarette in the past 30 days and never using HTPs. The participants received follow-ups at 1 week and 1-, 3-, and 6-months postenrollment. The primary outcome was self-reported 7-day point prevalence of cigarette abstinence (PPA) at the 6-month follow-up. Secondary outcomes included reduction in cigarette smoking (excluding quitters), the number of cessation attempts, and the level of readiness to quit. ResultsThe self-reported 7-day PPA was statistically significantly lower among HTP users than among non-HTP users after 6 months (19.0% vs. 34.2%; p = 0.009), with an adjusted relative risk of 0.47 (95% confidence interval: 0.24–0.91; p = 0.03). The study identified no significant differences in secondary outcomes between the two groups. ConclusionsYouth HTP users were less likely to abstain from tobacco use than their non-HTP-using counterparts. These results suggest that HTPs should not be promoted as smoking cessation or reduction aids among the youth population.

Telephone counseling and quitline service: An opportunity for tobacco use cessation during the COVID-19 pandemic.

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