Study design for a proactive teachable moment tobacco treatment intervention among patients with pulmonary nodules

Stephanie Unger, Sara E. Golden, Anne C. Melzer, Nichole Tanner, Janaki Deepak, Molly Delorit, Jennifer Y. Scott, Christopher G. Slatore

Research output: Contribution to journalArticlepeer-review


Introduction: We developed Teachable Moment to Opt-Out of Tobacco (TeaM OUT) as a tobacco treatment intervention based on a foundation of a theoretical model of teachable moments, “naturally occurring life transitions or health events thought to motivate individuals to spontaneously adopt risk-reducing health behaviors”. The TeaM OUT intervention combines a teachable moment for patients with newly detected incidental pulmonary nodules with a proactive interactive voice response (IVR) system to increase connections to evidence-based tobacco treatment interventions. Methods: We will perform a convergent, nested observational mixed-methods study utilizing both randomized trial and observational methods to test the effectiveness and generalizability of the TeaM OUT intervention through three aims. Aim 1: Among patients recently diagnosed with a pulmonary nodule, we will utilize a pragmatic, stepped wedge randomized controlled design to evaluate the effectiveness of a proactive, teachable moment-based, tobacco treatment outreach intervention (TeaM OUT) on increasing engagement with tobacco treatment resources compared to Enhanced Usual Care. Aim 2: Using a longitudinal observational design, we will evaluate the association of receipt of the TeaM OUT intervention with seven-day point abstinence prevalence and quit motivation compared to Enhanced Usual Care. Aim 3: Qualitatively elicit perspectives from key stakeholders to inform acceptability and utility, implementation barriers and facilitators, and scalability of the TeaM OUT intervention. Discussion: We are hopeful that implementation of TeaM OUT will increase the number of patients who quit using cigarettes with subsequent improvements in their health.

Original languageEnglish (US)
Article number106908
JournalContemporary Clinical Trials
StatePublished - Oct 2022

Bibliographical note

Funding Information:
This study is supported by an award to Dr. Slatore from VA IIR 19-425. It is also supported by resources from the VA Portland Health Care System , Portland, OR.

Funding Information:
The purpose of this publication is to describe our study, Teachable Moment to Opt-Out of Tobacco (TeaM OUT): Protocol for a Stepped Wedge Cluster Randomized Trial. We will use a mixed-methods approach, including a pragmatic, stepped wedge cluster randomized, design, to determine if the TeaM OUT intervention motivates patients with incidentally-detected pulmonary nodules to connect to and utilize cessation resources through an interactive voice response (IVR) system. We aim to evaluate whether a proactive, low-cost solution, that takes advantage of a naturally occurring teachable moment, can increase cigarette abstinence. We hypothesize that patients included in the TeaM OUT group will have higher accession of cessation services compared to patients in a control group. This study is funded by the Department of Veterans Affairs (VA) Health Services Research & Development service (19-425). The VA Central Institutional Review Board approved this study at all study sites (#19-33).

Publisher Copyright:
© 2022


  • IVR system
  • Interactive voice response
  • Pulmonary nodules
  • Teachable moment
  • Tobacco treatment


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