Adherence improvement using Shared Decision in tobacco dependence treatment.

Open randomized controlled clinical trial.

Juan Pablo Aguilar T.1; Tarcisio M. Andrade 2;

1. Student, Postgraduate Program in Medicine and Health (PPgMS), Federal

University of Bahia, Salvador, BA, Brazil.

2. Professor. Postgraduate Program in Medicine and Health (PPgMS), Federal

University of Bahia, Salvador, BA, Brazil.

Adherence to tobacco dependence treatment increases the probability of quitting smoking.

Shared Decision (ShD) is the pinnacle of patient-centered care and it can improve the
adherence to tobacco dependence treatment. Objective: To compare the adherence to
tobacco dependence treatment between two groups of patients: control group - the type of
treatment is chosen by the physician, and intervention group - the type of treatment is
chosen using ShD. Method: Clinical trial with 12-week follow-up, 104 smokers were
recruiting and therapeutic resources recommended by INCA (Brazilian National Cancer
Institute) were used: Cognitive Behavioral Therapy (CBT), with or without drug therapy
(nicotine patch or bupropion). Results: 84 patients completed the study. Patients with ShD
(n=40) according to Morisky Green Scale had better adherence compared to control (42.9%
vs 8.8% p= 0.001); Absolute Risk Reduction (ARR) to not be adherent to the treatment of
44.1% (95%CI= 22.3 to 65.9) and a Number Needed to Treat of 3 (95%CI 2 to 5) to have
an adherent patient. Participation in CBT in the first month was higher in the ShD group
(97.5% vs 75.5%, p= 0.04); at the last month it was similar. At the end, abandonment was
higher in the control group (15.0% vs 38.6%, p= 0.015); ARR of 29.7% (CI= 7.8% - 51.5%).
Conclusion: Patients who had the opportunity to choose the type of treatment, had better
adherence compared with those patients who had a usual treatment. The use of ShD to
treat tobacco dependence does not deviate from the INCA criteria.