• David O Warner, Annie LeBlanc, Sandeep Kadimpati, Kristin S Vickers, Yu Shi, and Victor M Montori.
• From the Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota (D.O.W., S.K., Y.S.); Division of Health Care Policy and Research, Department of Health Services Research, Mayo Clinic, Rochester, Minnesota (A.L.); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (K.S.V.); and Knowledge and Evaluation Research Unit, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota (V.M.M.).
• Anesthesiology. 2015 Jul 1; 123 (1): 182818-28.

BackgroundDecision aids can increase patient involvement in decision-making about health care. The study goal was to develop and test a decision aid for use by clinicians in discussion options for changing smoking behavior before and after elective surgery.MethodsIn formative work, a decision aid was designed to facilitate patient-clinician discussion regarding three options: continue smoking, attempt a period of temporary abstinence, and attempt to quit smoking for good. A randomized, two-group pilot study was then conducted in smokers evaluated in preparation for elective surgery in a preoperative clinic to test the hypothesis that the decision aid would improve measures of decisional quality compared with usual care.ResultsThe final decision aid consisted of three laminated cards. The front of each card included a colorful graphic describing each choice; the reverse including two to three pros and cons for each decision, a simple graphic illustrating the effects of smoking on the body, and a motivational phrase. In the randomized trial of 130 patients, the decision aid significantly (P < 0.05) improved measures of decisional quality and patient involvement in decision making (Cohen's d effect sizes of 0.76 and 1.20 for the Decisional Conflict Scale and Observing PatienT involvement In decisiON-making scale, respectively). However, the decision aid did not affect any aspect of perioperative smoking behavior, including the distribution of or adherence to choices.ConclusionsAlthough the use of a decision aid to facilitate clinician-patient discussions regarding tobacco use around the time of surgery substantially improved measures of decisional quality, it alone did not change perioperative tobacco use behavior.

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