A multi-method evaluation of tobacco treatment trial recruitment messages for current smokers recently diagnosed with cancer: A pilot factorial randomized control trial (Preprint)

BACKGROUND A cancer diagnosis can catalyze motivation to quit smoking. Tobacco treatment trials (TTTs) offer evidence-based cessation resources but suffer from low accrual rates. Digital outreach through clinician-delivered videos may improve recruitment efforts. However, understanding of how best to frame trial information and promote participation among smokers with a recent diagnosis is limited. OBJECTIVE This study aimed to identify which message frames were most effective at promoting intent to talk to a doctor about participating in a TTT for smokers recently diagnosed with cancer. METHODS From February-April 2019, current smokers diagnosed within the past 24 months were recruited from a national online panel company to a multi-method pilot randomized trial (N=99). Participants were randomly assigned to 1 of 9 videos in a 2 x 3 plus control factorial design that tested 3 unique message frame: (1) proximal vs. distal threats of smoking, (2) costs of continued smoking vs. benefits of quitting, and (3) gains of participating vs. loss of not participating in a TTT. The primary outcome was self-assessed intent to talk to a doctor about participating in a TTT. Phase 1: Analysis of variance examined the main effect within each message factor level and compared to control condition. Other message evaluation and effectiveness measures were also collected. A multivariable model explored sociodemographic, smoking and cancer characteristics, and message measures associated with intent to talk to a doctor. Phase 2: Open-text evaluations of the messages were analyzed using natural language processing software (Leximancer) to generate a thematic concept map and Linguistic Inquiry Word Count to identify and compare prevalence of linguistic markers between message factors. RESULTS A total of 76 participants completed the intervention. Participants who received the cost of continued smoking message frame were significantly more likely to intend to talk to their doctor about participating in a TTT than those who received the benefits of quitting frame (Mcosts=5.13 vs. Mbenefits=4.23, P=.038). Participants who received the proximal risks of continued smoking message frame were significantly more likely to seek more information about participating (MDistal=4.83 vs. MProximal=5.55, P=.04), and those who received the losses of not participating frame reported significantly improved perceptions about smoking cessation research (MGain=3.98 vs. MLoss=4.38, P=.013). Male participants (P=.006) and those with greater message relevancy (P=.001) were significantly more likely to intend to talk to their doctor. Participants’ perceptions about their smoking habits, as well as their motivation and readiness to quit smoking, were the most prevalent themes in the open-text data. Differences across message frames in the percentage of affective words were identified. CONCLUSIONS Multi-method approaches are needed to develop evidence-based recruitment messages for patients recently diagnosed with cancer. Future TTTs should evaluate the effectiveness of different message frames on smoker enrollment rates. CLINICALTRIAL