Telehealth-delivered group smoking cessation for rural and urban participants: feasibility and cessation rates.

BACKGROUND: Large-group behavioral smoking cessation interventions are effective for helping people quit smoking, but have not been evaluated using videoconferencing technology for rural and remote participants who have no access to in-person cessation programs. The objectives of this study were to provide and evaluate an evidence-based group smoking cessation program for rural/remote smokers wishing to quit through a Telehealth videoconferencing link at their local Health Centre. METHODS: From September 2005 through April 2008, eight separate eight-session, 4 month long smoking cessation group programs were offered both in person to urban participants in Calgary and at up to six rural sites simultaneously via Telehealth videoconferencing. Quit rates were assessed at program completion, 6 and 12 month follow-up. Participants also provided evaluations of the program and technology. RESULTS: 554 smokers participated in the program: 370 in Calgary and 184 at various remote sites. Sixteen Telehealth sites participated from across Alberta and one site from the Northwest Territories. After program completion, continuous abstinence rates using the most conservative intent-to-treat method were 27.5% in Calgary and 25.5% for the rural Telehealth sites. Quit numbers were much higher using only Available Data at 39.2% for Calgary and 37.2% for the rural sites. Similar rates were maintained over the 12-month follow-up. Program evaluations were positive. CONCLUSIONS: It is possible to offer effective smoking cessation to small groups of patients in rural or remote locations through Telehealth videoconferencing technology, which produces quit rates similar to in-person groups.

Screening for distress in lung and breast cancer outpatients: a randomized controlled trial.

PURPOSE: Distress has been recognized as the sixth vital sign in cancer care and several guidelines recommend routine screening. Despite this, screening for distress is rarely conducted and infrequently evaluated. METHODS: A program of routine online screening for distress was implemented for new patients with breast and lung cancer. Patients were randomly assigned to one of three conditions: (1) minimal screening: the distress thermometer (DT) only plus usual care; (2) full screening: DT, problem checklist, Psychological Screen for Cancer part C measuring anxiety and depression, a personalized report summarizing concerns and the report on the medical file; or (3) triage: full screening plus optional personalized phone triage with referral to resources. Patients in all conditions received an information packet and were reassessed 3 months later with the full screening battery. RESULTS: Five hundred eighty-five patients with breast cancer and 549 patients with lung cancer were assessed at baseline (89% of all patients), and 75.5% retained for follow-up. High prevalence of baseline distress was found across patients. Twenty percent fewer patients with lung cancer in triage continued to have high distress at follow-up compared to those in the other two groups, and patients with breast cancer in the full screening and triage conditions showed lower distress at follow-up than those in minimal screening. The best predictor of decreased anxiety and depression in full screening and triage conditions was receiving a referral to psychosocial services. CONCLUSION: Routine online screening is feasible in a large cancer center and may help to reduce future distress levels, particularly when coupled with uptake of appropriate resources.