TRIDENT
Title – Tobacco risk reDuctions with E-Cigarette Nicotine Therapy among adults with serious MI (TRIDENT). Being led from Oxford University by Professor Paul Aveyard.
Aims To develop a brief offer of an e-cigarette, and a continued support programme given by mental health professionals (MHPs) that meets the needs of people with serious mental illness (SMI) who smoke and have declined help to quit. To assess if this offer can promote e-cigarette use, cigarette reduction, and quitting. Background People with SMI (schizophrenia or bipolar disorder) are more likely to smoke, consequently developing heart disease and cancers 10-20 year earlier than people without. People who decline help to stop smoking can be helped to reduce, with 90% accepting an e-cigarette, 68% regularly using it, and 20% halving cigarette consumption. However, in our previous study, early success did not lead to quitting completely. People who cannot contemplate stopping smoking need more support to achieve this. Continued skilled support has been shown to improve sustained quitting in people with SMI. Methods Working with MHPs and people with SMI who smoke, we aim to understand their thoughts on being offered e-cigarettes when seeing an MHP and their needs for continued support for smoking reduction and eventually quitting. We will ask people with SMI to think aloud about their responses and thoughts listening to anonymous clips from consultations of GPs offering e-cigarettes to patients who smoke to reduce (not stop) smoking. We will do the same with MHPs. Additionally, we will identify the most appropriate ways to support smoking reduction and quit attempts, adapting these by consulting with people with SMI and MHPs. Once we have a brief offer and a support programme, we will assess whether we can recruit people with SMI and whether MHPs deliver the intervention as intended. We will assess whether people with SMI accept the e-cigarette, use it, and engage with the support programme. Using pre-set criteria, we will assess whether to proceed to a large-scale study. This study will be large enough to reliably assess whether the offer of the e-cigarette and ongoing support means people with SMI are more likely to stop smoking. We will assess whether the costs of this intervention are worth the benefits to health from stopping smoking. Patient and Public Involvement (PPI) Our SMI PPI panel were enthusiastic about this research. The panel supported gradual smoking reduction rather than quitting abruptly, and strongly advocated continued support. We will recruit people with experience of SMI and smoking to help determine whether we have adapted our programmes sufficiently to move to the next stage in this programme of research. Sharing findings Working through the NHS planning group on smoking, we will assess how this programme can be integrated into NHS care. If the intervention proves effective, we will work with our PPI group to explain and gather support for this approach.
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