Abstract / Summary
Background. Despite evidence that quitting smoking improves cancer treatment and outcomes, about one in eight patients with cancer smokes cigarettes. Barriers to quitting include difficulty managing cancer related emotions and distress without smoking and low self efficacy for quitting. Patients who continue to smoke may benefit from targeted therapies beyond motivational and cognitive approaches commonly used in standard-of-care smoking cessation treatment. Previous studies using Dialectical Behavior Therapy Skills Training (DBT-ST) successfully improved coping skills and outcomes for patients with substance use disorders and patients with breast cancer, but DBT-ST has yet to be applied to smoking among cancer populations. We developed an eight-session virtual group DBT-ST intervention to teach mindfulness, emotion regulation, and distress tolerance coping skills to patients with cancer who continue to smoke. Primary Aim. To improve our intervention before feasibility testing in a clinical trial, we solicited critiques and commentary on key intervention components from patients with cancer and smoking histories and their multidisciplinary clinical team. Methods. Within a pragmatist paradigm, we used qualitative description to conduct semi structured qualitative interviews with two groups: eight patients with cancer who smoked or had quit and nine oncology clinicians (physicians, psychotherapists, and nurses). The interviews were analyzed using codebook thematic analysis. Results. Patients and clinicians supported intervention components for smoking cessation, particularly its group format and teaching DBT-ST skills for being present, managing emotions, and handling distress. Participants noted perceived benefits including improved quality of life, decreased anxiety and depression, and acquisition of universal skills for managing life challenges. Other components, such as a virtual setting and the inclusion of patients not ready to quit, received mixed reviews. Conclusions. Results indicate early enthusiasm for our DBT-ST intervention for patients with cancer who smoke cigarettes, supporting progression to a feasibility study following specified modifications to intervention components.